Top

Surgical Endoscopy

Published in:

01-12-2012

Reduced port versus conventional laparoscopic total proctocolectomy and ileal J pouch-anal anastomosis

Authors: Meagan M. Costedio, Erman Aytac, Emre Gorgun, Ravi P. Kiran, Feza H. Remzi

Published in: Surgical Endoscopy | Issue 12/2012

Abstract

Background

The feasibility and safety of single-incision laparoscopic total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) were first reported in 2010. To improve accuracy and efficiency while maintaining the cosmetic advantages of single-incision laparoscopic surgery, we have since modified the technique to include the use of a 5-mm instrument placed through the eventual drain site. The aim of this study is to compare reduced port laparoscopic (RPL) IPAA with conventional laparoscopic IPAA with respect to short-term outcomes to assess safety.

Methods

RPL cases were matched to conventional laparoscopy cases for patient age (±5 years), body mass index, gender, diagnosis, type and number of stages of surgical procedure, American Society of Anesthesiologists (ASA) classification, and year of surgery (±3 years). Groups were compared using χ ² or Fisher exact tests for categorical and Wilcoxon rank-sum test for quantitative data.

Results

Twenty-four RPL patients were case-matched to an equal number of patients who underwent conventional laparoscopic IPAA. Short-term outcomes including postoperative complications, length of hospital stay, and time to first bowel movement were similar between groups. Despite similar diagnosis, previous surgery, and comorbidity, operative blood loss (p < 0.001) and operating time (p = 0.02) were lower for the RPL group.

Conclusion

RPL IPAA can be safely performed with short-term outcomes comparable to conventional laparoscopy.

Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. BMJ 2:85–88PubMedCrossRef

Cooperman AM, Katz V, Zimmon D, Botero G (1991) Laparoscopic colon resection: a case report. J Laparoendosc Surg 1:221–224PubMedCrossRef

Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1:217–220PubMedCrossRef

Fleming FJ, Francone TD, Kim MJ, Gunzler D, Messing S, Monson JR (2011) A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis. Dis Colon Rectum 54:176–182PubMedCrossRef

Braga M, Vignali A, Zuliani W, Radaelli G, Gianotti L, Martani C, Toussoun G, Di Carlo V (2002) Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial. Dis Colon Rectum 45:1070–1077PubMedCrossRef

Indar AA, Efron JE, Young-Fadok TM (2009) Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc 23:174–177PubMedCrossRef

Geisler DP, Kirat HT, Remzi FH (2011) Single-port laparoscopic total proctocolectomy with ileal pouch-anal anastomosis: initial operative experience. Surg Endosc 25:2175–2178PubMedCrossRef

Papaconstantinou HT, Sharp N, Thomas JS (2011) Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg 213:72–80PubMedCrossRef

Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826PubMedCrossRef

10.

Geisler DP, Condon ET, Remzi FH (2010) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 2:941–943CrossRef

11.

El-Gazzaz GS, Kiran RP, Remzi FH, Hull TL, Geisler DP (2009) Outcomes for case-matched laparoscopically assisted versus open restorative proctocolectomy. Br J Surg 96:522–526PubMedCrossRef

12.

Ahmed I, Paraskeva P (2011) A clinical review of single-incision laparoscopic surgery. Surgeon 9:341–351PubMedCrossRef

13.

Fichera A, Zoccali M, Gullo R (2011) Single incision (“scarless”) laparoscopic total abdominal colectomy with end ileostomy for ulcerative colitis. J Gastrointest Surg 15:1247–1251PubMedCrossRef

14.

Hamzaoglu I, Karahasanoglu T, Baca B, Karatas A, Aytac E, Kahya AS (2011) Single-port laparoscopic sphincter-saving mesorectal excision for rectal cancer: report of the first 4 human cases. Arch Surg 146:75–81PubMedCrossRef

15.

Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP (2011) Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum 54:183–186PubMedCrossRef

16.

Gandhi DP, Ragupathi M, Patel CB, Ramos-Valadez DI, Pickron TB, Haas EM (2010) Single-incision versus hand-assisted laparoscopic colectomy: a case-matched series. Gastrointest Surg 14:1875–1880CrossRef

17.

Kurmann A, Vorburger SA, Candinas D, Beldi G (2011) Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc 25:3531–3534PubMedCrossRef

18.

Hübner M, Diana M, Zanetti G, Eisenring MC, Demartines N, Troillet N (2011) Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon. Arch Surg 146:1240–1245PubMedCrossRef

19.

Koh MBC, Hunt BJ (2003) The management of perioperative bleeding. Blood Rev 17:179–185PubMedCrossRef

20.

Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB, Haas EM (2012) Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc 26:96–102PubMedCrossRef

21.

Adair J, Gromski MA, Lim RB, Nagle D (2010) Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport right colectomy. Dis Colon Rectum 53:1549–1554PubMedCrossRef

22.

Waters JA, Guzman MJ, Fajardo AD, Selzer DJ, Wiebke EA, Robb BW, George VV (2010) Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum 53:1467–1472PubMedCrossRef

Title: Reduced port versus conventional laparoscopic total proctocolectomy and ileal J pouch-anal anastomosis
Authors: Meagan M. Costedio
Erman Aytac
Emre Gorgun
Ravi P. Kiran
Feza H. Remzi
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 12/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2372-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Reduced port versus conventional laparoscopic total proctocolectomy and ileal J pouch-anal anastomosis

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2012

The long-term efficacy of laparoscopic surgery in early and advanced gastric cancer

Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias

Modified single-port laparoscopic herniorrhaphy for pediatric inguinal hernias: based on 1,107 cases in China

Practice gaps in gastrointestinal and endoscopic surgery (2011): a report from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) Continuing Education Committee

Heat loss during carbon dioxide insufflation: comparison of a nebulization based humidification device with a humidification and heating system

Is laparoscopic surgery for recurrent Crohn’s disease beneficial in patients with previous primary resection through midline laparotomy? A case-matched study