Laparoscopic total colectomy: Does the indication influence the outcome?

Table 1 Demographic and intraoperative data (mean ± SD) n (%)

	Crohn (n = 2)	Ulcerative colitis (n = 11)	FAP (n = 40)	Lynch syndrome (n = 5)	Constipation (n = 7)	Diverticulosis (n = 1)	All (n = 66)
Age (yr)	28.0 ± 9.7	42.5 ± 12.7	46.1 ± 19.4	44.8 ± 19.6	36.4 ± 8.9	57.0 ± 0.0	44.4 ± 17.0
Female	0	3 (27.3)	17 (42.5)	1 (20)	7 (100)	0	28 (42.4)
Operative time (h)	4.0 ± 0.0	4.6 ± 0.5	4.5 ± 1.5	4.1 ± 1.3	4.2 ± 1.0	5.0 ± 0.0	4.5 ± 1.24
Stoma	1 (50.0)	0	0	0	0	0	1 (1.5)
Conversion	0	2 (18.2)	6 (15)	0	1 (14.3)	0	9 (13.6)
Anastomosis
Ileorectal	0	3 (27.3)	37 (92.5)	4 (80)	1 (14.3)	1 (100)	46 (69.7)
Ileo-distal sigmoid	2 (100)	8 (72.7)	3 (7.5)	1 (20)	6 (85.7)	0	20 (30.3)

FAP: Familial adematous polyposis.

Table 2 Outcomes based on indication for surgery (mean ± SD) n (%)

	Inflammatory bowel disease (n = 13)	Other indications (n = 53)	P value
Age (yr)	42.5 (12.6)	44.9 (18.3)	0.663
Female	3 (23.1)	25 (47.2)	0.115
Operative time (h)	4.5 ± 0.5	4.40 ± 1.36	0.899
Conversion	2 (15.4)	7 (13.2)	> 0.999
Length of stay (d)	15.2 ± 7.5	12.8 ± 6.7	0.274
Time to first bowel movement (days from surgery)	4.9 ± 3.1	4.3 ± 3.1	0.522
Nasogastric tube1	9 (69.2)	25 (47.2)	0.154
Overall morbidity	5 (38.5)	19 (35.8)	> 0.999
Anastomotic leak	3 (23.1)	1 (1.9)	0.022
Reoperation	3 (23.1)	6 (11.3)	0.364
Radiological drainage	1 (7.7)	3 (5.7)	> 0.999

¹Numbers of patients (%) requiring a nasogastric tube for more than 1 postoperative day when inserted intraoperatively or requiring postoperative insertion.

Table 3 Comparison of outcomes over 2 consecutive time periods (mean ± SD) n (%)

	1998-2002 (n = 21)	2003-2007 (n = 45)	P value
Inflammatory bowel disease	10 (47.6)	3 (6.7)	< 0.0001
Operative time (h)	5.0 ± 0.9	4.2 ± 1.3	0.0156
Conversion	4 (19.0)	5 (11.1)	0.4499
Length of stay (d)	16.5 ± 7.9	11.8 ± 5.9	0.0093
Time to first bowel movement (days from surgery)	5.1 ± 3.5	4.1 ± 2.8	0.2439
Overall morbidity	10 (47.6)	14 (31.1)	0.1941
Anastomotic leak	2 (9.5)	2 (4.4)	0.5865
Reoperation	5 (23.8)	4 (8.9)	0.1300

Table 4 Early postoperative results (mean ± SD) n (%)

	Crohn (n = 2)	Ulcerative colitis (n = 11)	FAP (n = 40)	Lynch syndrome (n = 5)	Constipation (n = 7)	Diverticulosis (n = 1)	All (n = 66)
Length of stay (d)	17.5 ± 9.2	14.7 ± 7.6	11.2 ± 4.4	12.8 ± 6.9	13.7 ± 7.9	13 ± 0	13.3 ± 6.7
First bowel movement (d)	5.5 ± 3.5	4.8 ± 3.2	3.7 ± 2.7	4.6 ± 3.2	7.1 ± 4.1	5 ± 0	4.4 ± 3.1
Nasogastric tube1	1 (50)	7 (63.6)	19 (47.5)	1 (20)	4 (57.1)	1 (100)	34 (51.5)
Complications	2 (100)	3 (27.3)	11 (27.5)	4 (80)	3 (43)	1 (100)	24 (36.4)
Anastomotic leak	2 (100)	1 (9.1)	0	0	1 (14.3)	0	4 (6.1)
Wound abscess	0	0	2 (5)	1 (20)	1 (14.3)	0	4 (6.1)
Surgery for bowel obstruction	0	0	1 (2.5)	0	1 (14.3)	0	2 (3)
Other complications	0	2 (18.2)	8 (20)	3 (60)	0	1 (100)	14 (21.2)
Reoperation	2 (100)	1 (9.1)	3 (7.5)	0	2 (28.6)	1 (100)	9 (13.6)
Radiological intervention	1 (50)	0	3 (7.5)	0	0	0	4 (6.1)

¹Numbers of patients (%) requiring a nasogastric tube for more than 1 postoperative day when inserted intraoperatively or requring postoperative insertion. FAP: Familial adenomatous polyposis.

Table 5 Studies of total and segmental colectomy

Authors	Indication	No. of patients	Procedure	Conversion (%)	Morbidity (%)	Anastomotic leaks (%)	Reoperation (%)	Hospital stay (d)
Hamel et al[3]	Crohn	21	STC (L)	24	33	10	10	8.8
Pokala et al[11]	FAP, C, Lynch, IBD	34	TC + STC (L)	11.8	26.5	5.9	8.8	4.1
		34	TC + STC (O)	NA	38.2	0	11.8	6.8
Hsiao et al[4]	C	44	TC (HA)	0	18.2	2.3	6.8	7.6
Delaney et al[1]	Cancer, IBD, DD	11 044	SegC (L)	10.1	26	0.26	0.5	6.3
		21 689	SegC (O)	NA	31.8	0.18	0.3	8.5
Current series	IDB	13	TC + STC (L)	15.2	38.5	23.1	23.1	15.2
	Non IBD	53		13.2	35.8	1.9	11.3	12.8
	All	66		13.6	36.4	6.1	13.6	13.3

STC: Subtotal colectomy; TC: Total colectomy; SegC: Segmental colectomy; L: Laparoscopic; O: Open; HA: Hand assisted; FAP: Familial adenomatous polyposis; C: Slow transit Constipation; IBD: Inflammatory bowel disease; DD: Diverticular disease; NA: Not applicable.