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Effects of minimizing access trauma in laparoscopic colectomy in patients with IBD

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Abstract

Background

Laparoscopic interventions to minimize access trauma are increasingly gaining importance for both cosmetic reasons and lower postoperative morbidity. The aim of this study was to compare the clinical outcomes for different laparoscopic colectomy and proctocolectomy accesses considering IBD. A comparison was made between total laparoscopic (LR)—without an extra incision for sample —and laparoscopic-assisted resection using a small incision for retrieval of the specimen (LAR)

Patients and methods

From 2006 to 2012, 109 IBD patients underwent minimal invasive total colectomy or proctocolectomy. Patients were subdivided according to access into LR and LAR. Perioperative outcomes were evaluated.

Results

86 patients with Ulcerative Colitis (UC) and 23 with Crohn’s disease (CD) were included (LR: 64 UC/13 CD, LAR: 22 UC/10 CD). Among them, there were no differences in age, BMI, sex, ASA score or pre-existing immunosuppression. Patients with LR and UC had a higher disease activity score (Truelove III LR: 42 %, LAR: 5 %; p = 0.005). The Crohn’s Disease Activity Index did not differ. Patients with LR had a shorter operating time (LR: 211.5, LAR: 240 min; p = 0.002). There was no significant difference in hospital stay (LR: 11, LAR: 12.5 days; p ≥ 0.05), length of stay at the ICU (both 1 days; p ≥ 0.05), duration of required analgesia (LR: 7 days, LAR: 8 days; p ≥ 0.05), and nutritional build-up (both 5 days; p ≥ 0.05). Groups had the same overall complication rate, but surgical site infection rates tended to be higher in patients with LAR (LR: 9.1 %, LAR: 21.9 %, p = 0.07).

Discussion

Laparoscopic procedures for colectomy and proctocolectomy are safe and effective techniques for patients with colon involvement and IBD. Minimizing the access trauma in laparoscopic colectomy offers a potential advantage of reduced surgical site infections, especially for frequently immunosuppressed IBD patients.

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Acknowledgments

CS, JPR, and HJB conceived the idea and designed this study. CS and JG conducted the statistical analysis and drafted the manuscript. JPR, HJB, and AK carried out the samples. JG conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

Disclosure

Drs. Claudia Seifarth, Joerg-Peter Ritz, Anton Kroesen, Heinz J. Buhr, and Joern Groene have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Chirurgische Klinik I, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Claudia Seifarth, Heinz J. Buhr & Joern Groene

  2. Department of General and Visceral Surgery, Helios Kliniken, Schwerin, Germany

    Joerg-Peter Ritz

  3. Department of General, Visceral and Trauma Surgery, Medical Center Porz am Rhein, Cologne, Germany

    Anton Kroesen

Authors
  1. Claudia Seifarth
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  2. Joerg-Peter Ritz
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  3. Anton Kroesen
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  4. Heinz J. Buhr
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  5. Joern Groene
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Corresponding author

Correspondence to Claudia Seifarth.

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Appendix

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Seifarth, C., Ritz, JP., Kroesen, A. et al. Effects of minimizing access trauma in laparoscopic colectomy in patients with IBD. Surg Endosc 29, 1413–1418 (2015). https://doi.org/10.1007/s00464-014-3817-y

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  • DOI: https://doi.org/10.1007/s00464-014-3817-y

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