Surgical Endoscopy

, Volume 26, Issue 12, pp 3495–3499 | Cite as

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

  • Meagan M. Costedio
  • Erman Aytac
  • Emre Gorgun
  • Ravi P. Kiran
  • Feza H. Remzi
Article
First Online:
Received:
Accepted:

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.

Keywords

Reduced port Conventional laparoscopy Ileal pouch anal anastomosis 
This is a preview of subscription content, log in to check access.

Notes

Disclosures

Drs. Meagan M. Costedio, Erman Aytac, Emre Gorgun, Ravi P. Kiran, and Feza H. Remzi have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. BMJ 2:85–88PubMedCrossRefGoogle Scholar
  2. 2.
    Cooperman AM, Katz V, Zimmon D, Botero G (1991) Laparoscopic colon resection: a case report. J Laparoendosc Surg 1:221–224PubMedCrossRefGoogle Scholar
  3. 3.
    Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1:217–220PubMedCrossRefGoogle Scholar
  4. 4.
    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 54:176–182PubMedCrossRefGoogle Scholar
  5. 5.
    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 45:1070–1077PubMedCrossRefGoogle Scholar
  6. 6.
    Indar AA, Efron JE, Young-Fadok TM (2009) Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc 23:174–177PubMedCrossRefGoogle Scholar
  7. 7.
    Geisler DP, Kirat HT, Remzi FH (2011) Single-port laparoscopic total proctocolectomy with ileal pouch-anal anastomosis: initial operative experience. Surg Endosc 25:2175–2178PubMedCrossRefGoogle Scholar
  8. 8.
    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 213:72–80PubMedCrossRefGoogle Scholar
  9. 9.
    Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826PubMedCrossRefGoogle Scholar
  10. 10.
    Geisler DP, Condon ET, Remzi FH (2010) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 2:941–943CrossRefGoogle Scholar
  11. 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 96:522–526PubMedCrossRefGoogle Scholar
  12. 12.
    Ahmed I, Paraskeva P (2011) A clinical review of single-incision laparoscopic surgery. Surgeon 9:341–351PubMedCrossRefGoogle Scholar
  13. 13.
    Fichera A, Zoccali M, Gullo R (2011) Single incision (“scarless”) laparoscopic total abdominal colectomy with end ileostomy for ulcerative colitis. J Gastrointest Surg 15:1247–1251PubMedCrossRefGoogle Scholar
  14. 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 146:75–81PubMedCrossRefGoogle Scholar
  15. 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 54:183–186PubMedCrossRefGoogle Scholar
  16. 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 14:1875–1880CrossRefGoogle Scholar
  17. 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 25:3531–3534PubMedCrossRefGoogle Scholar
  18. 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 146:1240–1245PubMedCrossRefGoogle Scholar
  19. 19.
    Koh MBC, Hunt BJ (2003) The management of perioperative bleeding. Blood Rev 17:179–185PubMedCrossRefGoogle Scholar
  20. 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 26:96–102PubMedCrossRefGoogle Scholar
  21. 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 53:1549–1554PubMedCrossRefGoogle Scholar
  22. 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 53:1467–1472PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Meagan M. Costedio
    • 1
  • Erman Aytac
    • 1
  • Emre Gorgun
    • 1
  • Ravi P. Kiran
    • 1
  • Feza H. Remzi
    • 1
  1. 1.Department of Colorectal Surgery, Digestive Disease InstituteThe Cleveland Clinic FoundationClevelandUSA

Personalised recommendations