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Significantly Increased Pregnancy Rates After Laparoscopic Restorative Proctocolectomy: A Cross-Sectional Study.
MedLine Citation:
PMID:  22609840     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: To assess the impact of a laparoscopic approach on female fecundity in ileoanal pouch surgery. BACKGROUND:: Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is associated with tubal factor infertility in female patients. Different studies showed less adhesion formation after laparoscopic colectomy. The relation between laparoscopic pouch surgery and fertility, however, has not been studied so far. METHODS:: This cross-sectional study was carried out in 3 university hospitals in the Netherlands and in Belgium. Female patients older than 18 years that had IPAA under the age of 41 were eligible for inclusion (n = 179). We sent them a questionnaire addressing medical and fertility history. The primary endpoint was time to first spontaneous pregnancy after IPAA. This study has been registered with ISRCTN.org (ISRCTN85421386). RESULTS:: Of 179 eligible patients, 160 (89%) returned the questionnaire. After IPAA, 50 (31%) patients attempted to conceive. Of these, 23 (46%) had undergone open and 27 (54%) had undergone laparoscopic IPAA. Patient characteristics were similar in both groups. Indications for surgery were ulcerative colitis (UC) in 37 patients, familial adenomatous polyposis (FAP) in 12 patients, and colonic ischemia in 1 patient. A Kaplan-Meier survival function was plotted for time to first spontaneous pregnancy and showed a higher pregnancy rate after laparoscopic IPAA (log-rank, P = 0.023). Similarly, subsequent survival analysis for all patients with UC showed an increased pregnancy rate for the laparoscopic group (log-rank, P = 0.033). CONCLUSIONS:: Pregnancy rates are significantly higher after laparoscopic IPAA. This makes the laparoscopic approach the method of choice in young women.
Authors:
Sanne Al Bartels; André Dʼhoore; Miguel A Cuesta; Alexandra J Bensdorp; Cees Lucas; Willem A Bemelman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-17
Journal Detail:
Title:  Annals of surgery     Volume:  -     ISSN:  1528-1140     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands †Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Belgium ‡Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands §Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands ‖Department of Clinical Epidemiology, Biostatics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
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