Abstract
PURPOSE: The aim of this study was to assess the functional outcome and the quality of life of laparoscopic-assisted ileal pouch-anal anastomosis compared with conventional ileal pouch-anal anastomosis. Further, body image and cosmesis were evaluated in both groups. METHODS: Sixteen patients who underwent a laparoscopic-assisted ileal pouch-anal anastomosis between March 1996 and September 1999 were matched with 19 patients who had a conventional ileal pouch-anal anastomosis. Patients were matched for the time period after surgery, distribution of familial adenomatous polyposis/ulcerative colitis, and one/two-stage procedure. Thirty-two patients agreed to fill out a set of questionnaires that assessed functional outcome, quality of life, body image, and cosmesis. Quality of life was measured with the Short Form 36 Health Survey questionnaire and the Gastrointestinal Quality of Life Index. The Body Image Questionnaire was used to measure patients' perceptions of and satisfaction with their own body and their attitude toward their bodily appearance (body image) and the degree of satisfaction of patients with respect to the physical appearance of the scar (cosmesis). RESULTS: Patients in the conventional group were older than patients in the laparoscopic-assisted group (mean 39.2±8.4vs. 30.6±7.1 years;P<0.01). No differences were found in functional outcome and quality of life. Satisfaction with the cosmetic result of the scar was significantly higher in the laparoscopic-assisted group compared with the conventional group. Body image score was higher in the laparoscopic-assisted group when compared with the conventional group, although not significant. CONCLUSIONS: The functional outcome and quality of life of laparoscopic-assisted ileal pouch-anal anastomosis is not different from conventional ileal pouch-anal anastomosis. In the long-term, better cosmesis is the most important advantage after laparoscopic surgery.
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References
Fazio VW, Ziv Y, Church JM,et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222:120–7.
Mowschenson PM, Critchlow JF, Peppercorn MA. Ileoanal pouch operation: long-term outcome with or without diverting ileostomy. Arch Surg 2000;135:463–5.
Fazio VW, O'Riordain MG, Lavery IC,et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999;230:575–84.
Reissman P, Salky BA, Pfeifer J, Edye M, Jagelman DG, Wexner SD. Laparoscopic surgery in the management of inflammatory bowel disease. Am J Surg 1996;171:47–50.
Hildebrandt U, Lindemann W, Kreissler-Haag D, Feifel G, Ecker KW. Laparoscopically-assisted proctocolectomy with ileoanal pouch in ulcerative colitis. [in German]. Zentralbl Chir 1998;123:403–5.
Santoro E, Carlini M, Carboni F, Feroce A. Laparoscopic total proctocolectomy with ileal J pouch-anal anastomosis. Hepatogastroenterology 1999;46:894–9.
Schmitt SL, Cohen SM, Wexner SD, Nogueras JJ, Jagelman DG. Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization? Int J Colorectal Dis 1994;9:134–7.
Meijerink WJ, Eijsbouts QA, Cuesta MA,et al. Laparoscopically assisted bowel surgery for inflammatory bowel disease: the combined experiences of two academic centers. Surg Endosc 1999;13:882–6.
Dunker MS, Stiggelbout AM, van Hogezand HR,et al. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease. Surg Endosc 1998;12:1334–40.
van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF. Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 1999;230:648–54.
Aaronson NK, Muller M, Cohen PD,et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998;51:1055–68.
Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User's Manual. Boston: The Health Institute, New England Medical Center, December 1994.
Eypasch E, Williams JI, Wood-Dauphinee S,et al. Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 1995;82:216–22.
Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM. Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 2000;43:326–32.
Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med 1996;334:835–40.
van Duijvendijk P, Slors JF, Taat CW,et al. Quality of life after total colectomy with ileorectal anastomosis or proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg 2000;87:590–6.
Schwartz CE, Sprangers MA. Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med 1999;48:1531–48.
Milsom JW, Ludwig KA, Church JM, Garcia-Ruiz A. Laparoscopic total abdominal colectomy with ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 1997;40:675–8.
Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill, 1994.
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Dunker, M.S., Bemelman, W.A., Slors, J.F.M. et al. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy. Dis Colon Rectum 44, 1800–1807 (2001). https://doi.org/10.1007/BF02234458
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DOI: https://doi.org/10.1007/BF02234458