SSAT - Is There a Difference in Short-Term Outcomes When Colonic J-Pouch Anal Anastomosis Reconstruction is Performed following Laparoscopic vs. Open Low Anterior Resection?

Back to 2016 Annual Meeting

Is There a Difference in Short-Term Outcomes When Colonic J-Pouch Anal Anastomosis Reconstruction is Performed following Laparoscopic vs. Open Low Anterior Resection?
Shaun R. Brown^*, David Margolin, Laura Altom, heather Green, Brian Kann, Charles Whitlow, David E. Beck, David Vargas
Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA

Purpose: Various reconstruction techniques following low anterior resection (LAR) have been described with potential short-term functional benefits attributed to creation of a neo-reservoir. To date, no study has assessed the safety of a colonic j-pouch anal anastomosis (CJPAA) reconstruction following laparoscopic vs. open LAR. The purpose of this study was to compare the short-term outcomes of laparoscopic vs. open CJPAA reconstruction after low anterior resection.

Methods: We identified patients by CPT procedure codes who underwent either an open (CPT 45119) or laparoscopic (CPT 45397) LAR for rectal neoplasia (ICD-9 diagnosis codes) followed by a CJPAA in the 2008-2013 ACS NSQIP database. Patients who underwent LAR for reasons other than neoplasia were excluded. Preoperative patient demographics, intraoperative data, and postoperative complications were compared. Bivariate analysis was performed to evaluate 30-day mortality, postoperative complications, and length of stay (LOS). Multivariate analysis was used to assess the impact of laparoscopic vs. open reconstructive technique on postoperative complications.

Results: A power analysis was performed for equality testing with a total of 1366 patients needed to provide an 80% power. A total of 1528 patients were included, 764 in the laparoscopic CJPAA group and 764 in the open group. Preoperative characteristics including age, diabetes, BMI, ASA, and wound classification were similar between groups (Table 1). There was no difference in the thirty-day mortality (0.52% open vs. 0.13% laparoscopic, p=0.3). Bivariate analysis demonstrated a shorter LOS (7.2 days vs. 8.1 days, p=0.001), and a lower rate of superficial surgical site infections (4% vs. 11.2%, p=0.001) in the laparoscopic vs. open group. In addition, patients in the laparoscopic CJPAA group required fewer postoperative transfusions (4.7% vs. 9.8%, p=0.001), and experienced a lower rate of postoperative myocardial infarctions (0% vs. 0.8%, p=0.03). Operative time was longer in the laparoscopic vs. open group (304 min vs. 258 min, p=0.0001). Multivariate analysis did not demonstrate any difference in regards to major complications between study groups. However, laparoscopic CJPAA was associated with a lower rate of minor complications (7.7% vs. 17.5%, p=0.001).

Conclusion: Laparoscopic LAR with CJPAA was associated with a shorter length of stay when compared to an open approach. While laparoscopic CJPAA resulted in less minor complications there was no difference in the rate of major complications between groups. Analysis of the ACS NSQIP dataset demonstrated that CJPAA reconstruction is safe following both laparoscopic and open low anterior resection for neoplasia.

Back to 2016 Annual Meeting