Diverting stoma in laparoscopic ileal pouch anastomosis: P118

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Aim:Open ileal pouch anal anastomosis (IPAA) had reached a high standard without diverting stoma. Our aim was to assess our rate of diverting stoma and its impact on postoperative outcomes after laparoscopic IPAA.Method:All patients undergoing a laparoscopic IPAA at our institution wereprospectively entered in a database.Results:Between 11/2004 and 02/2010, 71 patients (38 females, 54%) with a median age of 25 years (15-72) and median BMI of 21 (15-42) had a laparoscopic IPAA for familial adenomatous polyposis (n = 34), chronic ulcerative colitis (n = 36) and HNPCC (n = 1). Twenty-four patients hadprevious abdominal surgery. Laparoscopic IPAA was performed up-front in 49 patients, among whom 7(14%) had a diverting stoma and after a sub-total colectomy in 22, among whom 7(32%) had a diverting stoma. All patients but one had a hand-sewn anastomosis. Nine conversions (13%) were required. Sixteen patients had postoperative complication during the 90 days following sugery, construction of a stoma did not influence complication rate: 12/57(21%) vs 4/14(29%). Seven patients (10%) were reoperated and this rate was not influenced by thepresence of a diverting stoma.Conclusion:Laparoscopic IPAA can be safely performed without diverting stoma and hand-sewn anastomosis, as in the open approach, without increasing the morbidity rate.

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