Minimally invasive total proctocolectomy with brooke ileostomy for ulcerative colitis

Stefan D. Holubar, Antonio Privitera, Robert R. Cima, Eric Dozois, John H. Pemberton, David Larson

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Total proctocolectomy with Brooke ileostomy remains the optimal surgical procedure for select ulcerative colitis patients. However, few studies describe outcomes of minimally invasive total proctocolectomy with Brooke ileostomy. Our aim was to describe the safety and feasibility of these procedures by examining short-term (30-day) outcomes. Methods: Using a prospective database, we identified a cohort of patients who underwent laparoscopic total proctocolectomy with Brooke ileostomy at our institution from 2000-2007. Results are reported as median (range) or frequency (proportion). Results: Forty-four patients were included; age 65 years (54-73), 24 were male (55%), body mass index was 26.5 (22.1-30.2) kg/m2. Colitis duration was 66 months (24-240), and 40% had prior surgery. The indication for surgery was refractory colitis (82%) and neoplasia (18%). Factors influencing choice of total proctocolectomy with permanent ileostomy were advanced age in 18 (41%), lifestyle in 13 (30%), medical comorbidities in 11 (25%), fecal incontinence in 10 (23%), oncologic reasons in 3 (6.8%), and obesity in 3 (6.8%). Twenty-three (52%) operations were hand-assisted laparoscopic surgery, 13 (30%) were laparoscopic-assisted, and 8 (18%) were "laparoscopic-incisionless" with transanal specimen extraction. Two laparoscopic-assisted cases (4.6%) were converted. Operative time was 329 (272-402) minutes, and length of stay 5 (4-6) days. Major post-operative complications occurred in 4 (9%); there were no perioperative mortalities. Conclusions: Minimally invasive total proctocolectomy with Brooke ileostomy is a safe, feasible option for the surgical treatment of chronic ulcerative colitis, and is the procedure of choice for select patients.

Original languageEnglish (US)
Pages (from-to)1337-1342
Number of pages6
JournalInflammatory Bowel Diseases
Volume15
Issue number9
DOIs
StatePublished - 2009

Fingerprint

Ileostomy
Ulcerative Colitis
Colitis
Hand-Assisted Laparoscopy
Fecal Incontinence
Operative Time
Life Style
Comorbidity
Length of Stay
Body Mass Index
Obesity
Outcome Assessment (Health Care)
Databases
Safety
Mortality
Neoplasms

Keywords

  • Ileal pouch-anal anastomosis
  • Laparoscopic
  • Total proctocolectomy
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Minimally invasive total proctocolectomy with brooke ileostomy for ulcerative colitis. / Holubar, Stefan D.; Privitera, Antonio; Cima, Robert R.; Dozois, Eric; Pemberton, John H.; Larson, David.

In: Inflammatory Bowel Diseases, Vol. 15, No. 9, 2009, p. 1337-1342.

Research output: Contribution to journalArticle

Holubar, Stefan D. ; Privitera, Antonio ; Cima, Robert R. ; Dozois, Eric ; Pemberton, John H. ; Larson, David. / Minimally invasive total proctocolectomy with brooke ileostomy for ulcerative colitis. In: Inflammatory Bowel Diseases. 2009 ; Vol. 15, No. 9. pp. 1337-1342.
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abstract = "Background: Total proctocolectomy with Brooke ileostomy remains the optimal surgical procedure for select ulcerative colitis patients. However, few studies describe outcomes of minimally invasive total proctocolectomy with Brooke ileostomy. Our aim was to describe the safety and feasibility of these procedures by examining short-term (30-day) outcomes. Methods: Using a prospective database, we identified a cohort of patients who underwent laparoscopic total proctocolectomy with Brooke ileostomy at our institution from 2000-2007. Results are reported as median (range) or frequency (proportion). Results: Forty-four patients were included; age 65 years (54-73), 24 were male (55{\%}), body mass index was 26.5 (22.1-30.2) kg/m2. Colitis duration was 66 months (24-240), and 40{\%} had prior surgery. The indication for surgery was refractory colitis (82{\%}) and neoplasia (18{\%}). Factors influencing choice of total proctocolectomy with permanent ileostomy were advanced age in 18 (41{\%}), lifestyle in 13 (30{\%}), medical comorbidities in 11 (25{\%}), fecal incontinence in 10 (23{\%}), oncologic reasons in 3 (6.8{\%}), and obesity in 3 (6.8{\%}). Twenty-three (52{\%}) operations were hand-assisted laparoscopic surgery, 13 (30{\%}) were laparoscopic-assisted, and 8 (18{\%}) were {"}laparoscopic-incisionless{"} with transanal specimen extraction. Two laparoscopic-assisted cases (4.6{\%}) were converted. Operative time was 329 (272-402) minutes, and length of stay 5 (4-6) days. Major post-operative complications occurred in 4 (9{\%}); there were no perioperative mortalities. Conclusions: Minimally invasive total proctocolectomy with Brooke ileostomy is a safe, feasible option for the surgical treatment of chronic ulcerative colitis, and is the procedure of choice for select patients.",
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T1 - Minimally invasive total proctocolectomy with brooke ileostomy for ulcerative colitis

AU - Holubar, Stefan D.

AU - Privitera, Antonio

AU - Cima, Robert R.

AU - Dozois, Eric

AU - Pemberton, John H.

AU - Larson, David

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AB - Background: Total proctocolectomy with Brooke ileostomy remains the optimal surgical procedure for select ulcerative colitis patients. However, few studies describe outcomes of minimally invasive total proctocolectomy with Brooke ileostomy. Our aim was to describe the safety and feasibility of these procedures by examining short-term (30-day) outcomes. Methods: Using a prospective database, we identified a cohort of patients who underwent laparoscopic total proctocolectomy with Brooke ileostomy at our institution from 2000-2007. Results are reported as median (range) or frequency (proportion). Results: Forty-four patients were included; age 65 years (54-73), 24 were male (55%), body mass index was 26.5 (22.1-30.2) kg/m2. Colitis duration was 66 months (24-240), and 40% had prior surgery. The indication for surgery was refractory colitis (82%) and neoplasia (18%). Factors influencing choice of total proctocolectomy with permanent ileostomy were advanced age in 18 (41%), lifestyle in 13 (30%), medical comorbidities in 11 (25%), fecal incontinence in 10 (23%), oncologic reasons in 3 (6.8%), and obesity in 3 (6.8%). Twenty-three (52%) operations were hand-assisted laparoscopic surgery, 13 (30%) were laparoscopic-assisted, and 8 (18%) were "laparoscopic-incisionless" with transanal specimen extraction. Two laparoscopic-assisted cases (4.6%) were converted. Operative time was 329 (272-402) minutes, and length of stay 5 (4-6) days. Major post-operative complications occurred in 4 (9%); there were no perioperative mortalities. Conclusions: Minimally invasive total proctocolectomy with Brooke ileostomy is a safe, feasible option for the surgical treatment of chronic ulcerative colitis, and is the procedure of choice for select patients.

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