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Evidence summaries

Open Versus Laparoscopic (Assisted) Ileo Pouch Anal Anastomosis for Ulcerative Colitis and Familial Adenomatous Polyposis

There may not be differences in mortality or complication rates between open and laparoscopic approach to pouch surgery in patients with ulcerative colitis and familial adenomatous polyposis, but the laparoscopic approach may result in better cosmesis. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 11 studies (only 1 RCT, n=60) with a total of 607 subjects (516 with ulcerative colitis and 89 with familial adenomatous polyposis). Mortality was reported in 9 studies; there was zero mortality in both groups in 8 studies and in 1 study, 1 death occurred in the open group and no deaths in the laparoscopic group (no statistically significant difference). In the only RCT, there were 47% and 53% complication rates in the laparoscopic and open group, respectively (not statistically significant). There weren't differences in complication rates between the two groups in the non-RCTs either (37.6% in laparoscopic group vs. 41.5% in open group; RR 0.91, 95% CI 0.73 to 1.14; 8 studies, n=519). Readmission rates did not differ statistically significantly between the groups in the 2 studies reporting this outcome (in the RCT 22% and 13%, and in the non-RCT 21% and 22% in the laparoscopic and open group, respectively). The RCT reported 17% reoperations in both groups. In the non-RCTs there were 4.0% reoperations in the laparoscopic and 5.8% in the open group (RR 0.74, 95% CI 0.32 to 1.71; 6 studies, n=447). Operative time was significantly longer in the laparoscopic group both in the RCT and in meta-analysis of non-RCTs (WMD 91 minutes, 95% CI 53 to 130). There were no significant differences between the two groups regarding postoperative recovery parameters. Total incision length was significantly shorter in the laparoscopic group. Cosmesis scores were reported by 2 studies. The RCT showed a significant increase from a mean of 14.7 points in the open group to 18.5 in the laparoscopic groups (p=0.01). The non-RCT study reported an increase from a mean of 16 points in the open to 19.8 in the laparoscopic group (p=0.03). Other long-term outcomes were poorly reported.

Comment: The quality of evidence is downgraded by indirectness (lack of long-term outcomes) and by imprecise results (few outcome events).

    References

    • Ahmed Ali U, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, van Laarhoven CJ. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev 2009 Jan 21;(1):CD006267. [PubMed]

Primary/Secondary Keywords