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World Journal of Surgery

, Volume 42, Issue 11, pp 3746–3754 | Cite as

Case-Matched Comparison of Long-Term Functional and Quality of Life Outcomes Following Laparoscopic Versus Open Ileal Pouch-Anal Anastomosis

  • Olga A. Lavryk
  • Luca Stocchi
  • Jean H. Ashburn
  • Meagan Costedio
  • Emre Gorgun
  • Tracy L. Hull
  • Hermann Kessler
  • Conor P. Delaney
Original Scientific Report

Abstract

Background

Laparoscopic ileal pouch–anal anastomosis (IPAA) is associated with recovery benefits when compared with open IPAA. There is limited data on long-term quality of life and functional outcomes, which this study aimed to assess.

Methods

An IRB-approved, prospectively maintained database was queried to identify patients undergoing laparoscopic IPAA (L), case-matched with open IPAA (O) based on age ± 5 years, gender, body mass index (BMI) ± 5 kg/m2, diagnosis, date of surgery ± 3 years, stapled/handsewn anastomosis, omission of diverting loop ileostomy and length of follow-up ± 3 years. We assessed functional results, dietary, social, work, sexual restrictions and the Cleveland Clinic global quality of life score (CGQoL) at 1, 2, 3, 4, 5 and 10 years postoperatively. Functional outcomes were assessed based on number of stools (day/night) and seepage protection use (day/night). Variables were evaluated with Kaplan–Meier survival curves, uni- and multivariable analyses.

Results

Out of 4595 IPAAs, 529 patients underwent L, of whom 404 patients were well matched 1:1 to an equivalent number of O based on all criteria. Median follow-ups were 2 (0.5–17.8) versus 2.4 (0.5–22.2) years in L versus O, respectively (p = 0.18). L was associated with significantly decreased number of stools at night and less frequent pad usage at 1 year, both during the day and at night. Functional outcomes became similar during further follow-up. L was also associated with improved overall CGQoL, and energy scores at 1 year postoperatively, and decreased social restrictions for 1–2 years. There were no significant differences in quality of health, dietary, work or sexual restrictions. Laparoscopy was not associated with increased risk of pouch failure (p = 0.07) or significantly different causes of pouch failure when compared to O.

Conclusions

Laparoscopic and open IPAA are associated with equivalent long-term functional outcomes, quality of life and pouch survival rates. Laparoscopic technique is associated with temporary benefits lasting 1 or 2 years.

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Olga A. Lavryk
    • 1
  • Luca Stocchi
    • 1
  • Jean H. Ashburn
    • 1
  • Meagan Costedio
    • 1
  • Emre Gorgun
    • 1
  • Tracy L. Hull
    • 1
  • Hermann Kessler
    • 1
  • Conor P. Delaney
    • 1
  1. 1.Department of Colorectal Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandUSA

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