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Robotic-assisted reoperative ileal pouch–anal anastomosis: robotic pouch excision and pouch revision

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Abstract

Background

Up to 20% of patients with ileal pouch will develop pouch failure, ultimately requiring surgical reintervention. As a result of the complexity of reoperative pouch surgery, minimally invasive approaches were rarely utilized. In this series, we present the outcomes of the patients who underwent robotic-assisted pouch revision or excision to assess its feasibility and short-term results.

Methods

All the patients affected by inflammatory bowel diseases and familial adenomatous polyposis who underwent robotic reoperative surgery of an existing ileal pouch were included.

Results

Twenty-two patients were included; 54.6% were female. The average age at reoperation was 51 ± 16 years, with a mean body mass index of 26.1 ± 5.6 kg/m2. Fourteen (63.7%) had a diagnosis of ulcerative colitis at reoperation, and seven (31.8%) had Crohn’s disease. The mean time to pouch reoperation was 12.8 ± 11.8 years. Seventeen (77.3%) patients underwent pouch excision, and five (22.7%) had pouch revision surgery. The mean operative time was 372 ± 131 min, and the estimated blood loss was 199 ± 196.7 ml. The conversion rate was 9.1%, the 30-day morbidity rate was 27.3% (with only one complication reaching Clavien–Dindo grade IIIB), and the mean length of stay was 5.8 ± 3.9 days. The readmission rate was 18.2%, the reoperation rate was 4.6%, and mortality was nihil. All patients in the pouch revisional group are stoma-free.

Conclusion

Robotic reoperative pouch surgery in highly selected patients is technically feasible with acceptable outcomes.

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Data availability

No datasets were generated or analysed during the current study.

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Funding

This research did not receive external funding.

Author information

Author notes

  1. Tommaso Violante, Kevin T. Behm, and Sherief F. Shawki contributed equally to this work.

Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA

    Tommaso Violante, Kevin T. Behm, Sherief F. Shawki, Davide Ferrari, Anne-Lise D. D’Angelo, Scott R. Kelley & David W. Larson

  2. Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, ARZ, USA

    Tommaso Violante, Davide Ferrari & Mishra Nitin

  3. School of General Surgery, Alma Mater Studiorum, Università Di Bologna, Bologna, Italy

    Tommaso Violante & Davide Ferrari

  4. General Surgery Residency Program, University of Milan, Milan, Italy

    Davide Ferrari

Authors
  1. Tommaso Violante
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  2. Kevin T. Behm
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Contributions

Data acquisition: TV, DF, KB, SS. Drafting of manuscript: TV, KB, SS, DF. Critical review of manuscript: TV, KN, SS, DF, AD, SK, MN, DL.

Corresponding author

Correspondence to David W. Larson.

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The authors declare no conflict of interest.

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The institutional review board approved this study.

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All patients signed the Minnesota Research Authorization form.

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Violante, T., Behm, K.T., Shawki, S.F. et al. Robotic-assisted reoperative ileal pouch–anal anastomosis: robotic pouch excision and pouch revision. Tech Coloproctol 28, 43 (2024). https://doi.org/10.1007/s10151-024-02918-2

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  • DOI: https://doi.org/10.1007/s10151-024-02918-2

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