[Hand-assisted laparoscopic versus laparotomy in total proctocolectomy with ileal pouch-anal anastomosis: a clinical controlled study].

OBJECTIVE: To compare the outcomes of total proctocolectomy with ileal pouch-anal anastomosis performed by hand-assisted laparoscopic(HALS) and laparotomy. METHODS: Clinical data of 78 patients undergoing HALS(n=36) or laparotomy(n=42) from January 2009 to June 2011 were retrospectively studied. All the operations were performed by the same surgical group. Patients safety, postoperative recovery, complications were compared between the two groups. RESULTS: As compared to laparotomy group, HALS group had longer operative time[(300.3±56.4) min vs. (227.2±34.0) min, P=0.001], less intraoperative bleeding[(150.2±42.2) ml vs. (213.5±61.0) ml, P=0.043], shorter interval to first flatus[(2.4±0.9) d vs. (3.1±1.2) d, P=0.026], and shorter hospital stay[(9.3±2.6) d vs. (11.6±3.4) d, P=0.039]. There were no significant differences in the incidence of complications such as anastomotic separation, hemorrhage, wound infection, pelvic sepsis, and intestinal obstruction between the two groups(P>0.05). CONCLUSIONS: HALS is as safe as open approach for total proctocolectomy with ileal pouch-anal anastomosis, and short-term outcomes are better than laparotomy.