A comparison of laparoscopic and open restorative proctocolectomy in children

Aim

Restorative proctocolectomy (RP) is the gold standard for children requiring removal of their colon and rectum. The aim of this study is to contrast conventional (open) and laparoscopic RP.

Methods

All children undergoing RP by one surgeon were prospectively recorded in a customised database. Outcome variables were length of stay in days (LOS), duration of surgery in minutes (DS), blood loss in ml, and complications. Explanatory variables included technique of resection (open or laparoscopic (lap)) and presenting disease. Lap resection was adopted after patient 37. Data are presented as median (range). P < 0.05 was regarded as significant.

Results

Eighty-two (43 girls) children underwent RP at median age 12 (0.5–20) years. RP was performed as Open (n = 37) or Laparoscopic (n = 45). Indications were: colitis (n = 56), polyposis (n = 12), constipation (n = 7), Hirschsprung’s (n = 5), fibrosing colonopathy (n = 2). Significantly, more children had three-stage surgery among the lap group (P = 0.04). LOS was significantly shorter in the lap group 15 (8-114) days vs 17(13– 60) days; P = 0.04], but there was no difference in DS or complication rates between laparoscopic and open surgery. Laparoscopic surgery was associated with significantly lower blood loss 150 (0–840) ml vs. 334 (0-1480) ml; P = 0.02].

Conclusion

Laparoscopic RP is associated with lower blood loss, shorter LOS, but no difference in duration of surgery or complication rate.