Consecutive series of laparoscopic-assisted vs. minilaparotomy restorativeproctocolectomies

PURPOSE: Compared with open restorative proctocolectomy, laparoscopic proce dures may reduce postoperative recovery times and give a more cosmetically acceptable scar, but operative time may be prolonged. We describe a minilap arotomy technique for restorative proctocolectomy and compare recovery para meters with a laparoscopic procedure, METHODS: A consecutive series of pati ents undergoing laparoscopic-assisted restorative proctocolectomy were comp ared with a subsequent consecutive series of patients undergoing a minilapa rotomy procedure. This method incorporates a suprapubic incision. Mobilizat ion of the colon is performed in the usual manner with visualization of les s accessible areas made possible by using an illuminated St. Mark's retract or, Operative and recovery parameters were analyzed for each group retrospe ctively. RESULTS: Twenty-five patients were compared (12 in the laparoscopi c group). Wound length was significantly longer in the open group (median, 14 vs. 8.5 cm, P < 0.01), but operative rimes were shorter (median, 120 vs. 150 minutes; P < 0.01). There were no differences in any of the recovery p arameters analyzed, including analgesic requirements. time to ileostomy fun ction, first fluid intake, time to solid diet, length of hospital stay, and complications. CONCLUSION: The only advantage of a laparoscopic-assisted p rocedure over a minilaparotomy technique was the size of the wound. The min ilaparotomy restorative proctocolectomy achieves the same postoperative rec overy parameters and has a shorter operative time. This technique is recomm ended for surgeons less experienced in laparoscopy.