P442 Evaluation of safety and efficacy of laparoscopic surgery for ulcerative colitis
M. Yamamoto*, K. Kurachi, T. Harada
Hamamatsu University School of Medicine, Second Department of Surgery, Hamamatsu, Japan
Laparoscopic total colectomy has become increasingly used in the treatment of ulcerative colitis. We apply hand-assisted laparoscopic surgery (HALS) for ulcerative colitis from 2002 and total laparoscopic surgery since 2011. However, the safety and efficacy of these procedures have not fully investigated. Especially in the acute and fulminant cases, it is sometimes difficult to decide the indication of laparoscopic surgery. In this study, we assessed the safety and efficacy of total colectomy for ulcerative colitis by each surgical procedure; include laparotomy, HALS and total laparoscopy.
Eighty-one patients who have undergone total colectomy for ulcerative colitis from January 1996 to November 2014 have been analysed.
The number of patient who have undergone laparotomy (OP), HALS, and total laparoscopy (LAP) was 33, 31, and 19, respectively. The average operation time in OP, HALS, and LAP was 260 ± 91.1; 279.7 ± 83.2; and 376.2 ± 129.5 minutes, respectively, which showed significant longer operation time in the LAP group. However, the duration of hospital stay after operation was 35.3 ± 22.7; 29.5 ± 15.4; and 23.5 ± 10.1 days, and the amount of bleeding was 623 ± 876.4, 434.2 ± 277.9, and 149.6 ± 203.8ml respectively, which shows significant shorter hospital stay and less bleeding in LAP group (p < 0.01). In the LAP group, there were 7 fulminant cases that required emergency surgery, and 11 cases that underwent elective surgery. Preoperative WBC count was higher, and haemoglobin and serum albumin concentration was lower in the acute surgery group, which indicates a worse general condition before surgery in the acute group. However, as for operation time, bleeding, hospital stay, and postoperative complication were not different in each group, which suggests that LAP is also feasible for emergency surgery. In addition, from the patients’ survey after surgery, the patients in the LAP group were more satisfied cosmetically compared with other groups. There were no differences in the improvement of quality of life.
Total laparoscopic surgery is a safe and effective procedure even in emergency cases for the treatment of ulcerative colitis.