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DOP042 Omentectomy is not necessary during laparoscopic total coloproctectomy and ileal pouch-anal anastomosis for inflammatory bowel disease. A comparative study in 247 consecutive patients from 4 expert centres

Mege D.*1, Germain A.2, Stellingwerf M.3, Colombo F.4, Maggiori L.1, De Buck van Overstraeten A.2, Buskens C.3, Foschi D.4, Sampietro G.4, Bemelman W.3, D'Hoore A.2, Panis Y.1

1Beaujon Hospital, Colorectal Surgery, Clichy, France 2Leuven, Digestive Surgery, leuven, Belgium 3AMC, Digestive Surgery, Amsterdam, Netherlands 4ASST, Digestive Surgery, Milan, Italy

Background

Today, there is no consensus about the indication of associated omentectomy during the (sub)total colectomy. Data about its impact on later small bowel obstruction are conflicting. The objective was thus to evaluate possible impact of omentectomy during total coloproctectomy and ileal pouch-anal anastomosis (IPAA) for inflammatory bowel disease.

Methods

All the patients who underwent laparoscopic 2-stage IPAA for inflammatory bowel disease from 2005 to 2015 in 4 expert European centres were included and divided into 2 groups: omentectomy (Group A) and no omentectomy (Group B). Comparisons were performed between groups for the following findings: demographic features, inflammatory bowel disease characteristics, preoperative treatment in the three last months, intraoperative features, postoperative outcomes and long-term results.

Results

During the study period, 247 patients (148 males, median age =45 [14–78] years) were divided into Groups A (n=109) and B (n=138). Patients in Gr. A were more frequently under steroids before IPAA (63% vs 50%, p=0.04), and required more frequently conversion into laparotomy (6% vs 1%, p=0.02). Surgical morbidity rate (31% vs 33%, p=0.78), Dindo ≥3 morbidity (35 vs 39%; p=0.84) and unplanned reoperation (12 vs 16%; p=0.46) rates were similar in both groups. Median length of stay was longer in Gr. A than B (12 vs 10 days; p<0.0001). At the end of follow up, small bowel obstruction rate was higher in Gr. A than Gr. B (10 vs 1%; p=0.003).

Conclusion

This study suggests that omentectomy during laparoscopic IPAA do not modify operative results but seems to increase conversion rate, length of stay and long-term small bowel obstruction rates. Thus, omentectomy is probably not necessary during laparoscopic IPAA.