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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2020

01-01-2020 | Laparoscopy

Laparoscopic subtotal colectomy with double-end ileosigmoidostomy in right iliac fossa facilitates second-stage surgery in patients with inflammatory bowel disease

Authors: Diane Mege, Alice Frontali, Gianluca Pellino, Samuel Adegbola, Léon Maggiori, Janindra Warusavitarne, Yves Panis

Published in: Surgical Endoscopy | Issue 1/2020

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Abstract

Background

There is no consensus about the most appropriate management of rectal stump in laparoscopic subtotal colectomy (STC) performed for inflammatory bowel disease (IBD). The objective is to report our experience of laparoscopic STC with double-end ileosigmoidostomy in the right iliac fossa for IBD.

Methods

All patients undergoing laparoscopic STC and double-end ileosigmoidostomy in the right iliac fossa for IBD in 2 European expert centres were included.

Results

From 1999 to 2017, laparoscopic STC and double-end ileosigmoidostomy in right iliac fossa was performed in 213 consecutive patients, including 74 patients in an emergency setting (35%). Conversion to laparotomy was necessary in 9 patients (4%). One patient died postoperatively (0.5%). Postoperative morbidity occurred in 53 patients (25%) after STC, and was major in 18 patients (8%). A second stage was performed in 199 patients (94%), with a mean delay of 4.7 ± 6 months (range 1.4–77). The second stage was an ileorectal anastomosis (n = 50/199; 25%), performed by an elective open incision in the right iliac fossa in 68% of cases; an ileal pouch-anal anastomosis (IPAA) (n = 139; 70%) successfully performed by laparoscopy in 96% of cases; or an abdominoperineal excision with end ileostomy (n = 10; 5%) successfully performed by laparoscopy in 8 cases. After this second stage, postoperative morbidity occurred in 53 patients (27%), and was major in 15 patients (8%). After a mean follow-up of 3.7 ± 3 years (range 0.1–15), stoma rate (end ileostomy and diverting stoma not closed) was 17%, and small bowel obstruction and incisional hernia occurred in 10 (5%) and 25 (12%) patients, respectively.

Conclusions

Laparoscopic STC and double-end ileosigmoidostomy in right iliac fossa is safe, feasible, and facilitates the second stage for intestinal continuity by either elective incision or laparoscopy in 100% of ileorectal anastomoses and by laparoscopy in 96% of IPAA.
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Metadata
Title
Laparoscopic subtotal colectomy with double-end ileosigmoidostomy in right iliac fossa facilitates second-stage surgery in patients with inflammatory bowel disease
Authors
Diane Mege
Alice Frontali
Gianluca Pellino
Samuel Adegbola
Léon Maggiori
Janindra Warusavitarne
Yves Panis
Publication date
01-01-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06749-3

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