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Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent

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Abstract

Background

Minimally invasive approaches have become the standard of care for ileal pouch-anal anastomoses (IPAA). There are few reports comparing outcomes following a laparoscopic versus robotic approach. Our aim was to determine if there were any differences in the 30-day postoperative outcomes following IPAA performed laparoscopically versus robotically.

Methods

A retrospective chart review of all laparoscopic and robotic IPAA performed between January 1, 2015 and June 30, 2018 was carried out. Patients included were adult patients who underwent a proctectomy and IPAA utilizing either a laparoscopic or robotic approach. Data collected included patient demographics, operative variables, and 30-day postoperative outcomes.

Results

A total of 132 patients had a minimally invasive IPAA; 58 were performed laparoscopically and 74 robotically. Less than half the patients were female (n = 55; 41.7%) with a median age of 37 years (range 18–68 years). The majority of patients had a diagnosis of ulcerative colitis (n = 103; 78.0%) with medically refractory disease (n = 87; 65.9%). A greater proportion of patients in the laparoscopic cohort had a prolonged length of stay (n = 27; 46.6% versus n = 18; 24.3%; p < 0.001) and a two-stage approach (n = 56; 96.6% versus n = 37; 50%; p < 0.001), but there were no differences in the rates between the laparoscopic versus robotic cohorts of superficial surgical site infection (6.9% versus 6.8%; p = 0.99), peripouch abscess (15.5% versus 6.8%; p = 0.11), anastomotic leak (6.9% versus 2.7%; p = 0.21), pelvic abscess (15.5% versus 6.8%; p = 0.11), and pelvic sepsis (15.5% versus 6.8%; p = 0.11), readmission (24.1% versus 17.6%; p = 0.35) or reoperation (6.9% versus 5.4%; p = 0.72). On multivariable analysis, only male sex remained predictive of prolonged length of stay, and a robotic approach trended toward a decreased rate of prolonged length of stay.

Conclusions

Laparoscopic and robotic IPAA have equivalent postoperative morbidity underscoring the safety of the continued expansion of the robotic platform for pouch surgery.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    A. L. Lightner, F. Grass, N. P. McKenna, M. Tilman, A. Alsughayer, S. R. Kelley, K. Behm & D. W. Larson

  2. Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA

    A. Merchea

  3. Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    A. L. Lightner

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  1. A. L. Lightner
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  2. F. Grass
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All authors meet the three authorship criteria: substantial contribution, participation in drafting the article, and final approval.

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Correspondence to A. L. Lightner.

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Amy Lightner receives consultant fees from Takeda; all other authors: declare that they have no conflict of interest.

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Lightner, A.L., Grass, F., McKenna, N.P. et al. Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent. Tech Coloproctol 23, 259–266 (2019). https://doi.org/10.1007/s10151-019-01953-8

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  • DOI: https://doi.org/10.1007/s10151-019-01953-8

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