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Single incision laparoscopic (SILS) restorative proctocolectomy with ileal pouch-anal anastomosis

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Abstract

Background

Restorative proctocolectomy with ileoanal pouch is the definitive procedure in ulcerative colitis. The potential benefits afforded by a single incision laparoscopic (SILS) approach make it appropriate to consider.

Methods

Electronic data were prospectively collected from all patients who underwent SILS restorative proctocolectomy (SILS-RPC) between June 2009 and June 2010.

Results

Ten consecutive patients (4 male), with median BMI = 22 (range = 20–28 kg/m2) underwent SILS-LRPC over a 1-year period. Three had undergone a previous emergency laparoscopic colectomy. A single-port device (Covidien SILS™ or Olympus TriPort™) was positioned at the site of the existing or proposed temporary ileostomy (2.5-cm incision). The colon and rectum were extracted through the SILS site (n = 8) or transanally following a mucosectomy (n = 2). A 20-cm J pouch was constructed extracorporeally and returned via the ileostomy site. Pouch-anal anastomosis was performed intracorporeally (n = 8) or hand-sutured (n = 2) and a diverting loop ileostomy was created at the SILS port site. The median operation time was 185 min (range = 100–381). There were no conversions or additional ports required. Median time to full diet was 36 h (range = 4–48 h) with a median hospital stay of 3 days (range = 2–8 days). There were no 30-day readmissions. Complications included surgical emphysema with temperature and a panic attack. Nine stomas have been closed. All patients have spontaneity of defecation, with a median pouch frequency of four per day, including once at night. All are fully continent and able to defer during the day. One reported a dry ejaculate for 10 weeks.

Conclusion

SILS restorative proctocolectomy is safe with good early functional outcomes when performed by an experienced laparoscopic surgeon.

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References

  1. Ates O, Hakgüder G, Olguner M, Akgür FM (2007) Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture. J Pediatr Surg 42:1071–1074

    Article  PubMed  Google Scholar 

  2. Gumbs AA, Milone L, Sinha P, Bessler M (2009) Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 13:533–534

    Article  PubMed  Google Scholar 

  3. Hirano D, Minei S, Yamaguchi K, Yoshikawa T, Hachiya T, Yoshida T, Ishida H, Takimoto Y, Saitoh T, Kiyotaki S, Okada K (2005) Retroperitoneoscopic adrenalectomy for adrenal tumours via a single large port. J Endourol 19:788–792

    Article  PubMed  Google Scholar 

  4. Desai MM, Rao PP, Aron M, Pascal-Haber G, Desai MR, Mishra S, Kaouk JH, Gill IS (2009) Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int 101:83–88

    Article  Google Scholar 

  5. Remzi FH, Kirat HT, Kaouk HT, Kaouk JH, Geisier DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826

    Article  PubMed  CAS  Google Scholar 

  6. Rieger NA, Lam FF (2910) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surg Endosc 24:888–890

    Article  Google Scholar 

  7. Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824

    Article  PubMed  Google Scholar 

  8. Chambers W, Bicsak M, Lamparelli M, Dixon AR (2011) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13(4):393–398

    Article  PubMed  CAS  Google Scholar 

  9. Geisler DP, Condon ET, Remzi FH (2011) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12(9):941–943

    Article  Google Scholar 

  10. Dunker MS, Bemelman WA, Slores JF, van Duijvendijk P, Gouma DJ (2002) Functional outcome, quality of life, body image and cosmesis in patients after laparoscopic assisted and conventional restorative proctocolectomy. Dis Colon Rectum 44:1800–1807

    Article  Google Scholar 

  11. Ky AJ, Sonoda TM, Milsom JW (2002) One-stage laparoscopic restorative proctocolectomy: an alternative to the conventional approach? Dis Colon Rectum 45:207–211

    Article  PubMed  Google Scholar 

  12. Gill TS, Karantana A, Rees J, Pandey S, Dixon AR (2004) Laparoscopic proctocolectomy with retorative ileal-anal pouch. Colorectal Dis 6:458–461

    Article  PubMed  CAS  Google Scholar 

  13. Larson DW, Dozois EJ, Piotrowicz K, Cima RR, Wolff BG, Young Fadok TM (2005) Laparoscopic assisted vs open ileal pouch anal anastomosis: functional outcomes in a case matched series. Dis Colon Rectum 48:1845–1850

    Article  PubMed  Google Scholar 

  14. Kienle P, Z’graggen K, Schmidt J, Benner A, Weitz J, Buchler MW (2005) Laparoscopic restorative proctocolectomy. Br J Surg 92:88–93

    Article  PubMed  CAS  Google Scholar 

  15. Larson DW, Cima RR, Dozois EJ, Davies M, Piotrowicz K, Barnes SA, Wolff B, Pemberton J (2006) Safety, feasibility and short-term outcomes of laparoscopic ileal pouch anal anastomosis: a single institutional case-matched experience. Ann Surg 243:667–670

    Article  PubMed  Google Scholar 

  16. McAllister I, Sagar PM, Brayshaw I, Gonsalves S, Williams GL (2009) Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy. Colorectal Dis 11:296–301

    Article  PubMed  CAS  Google Scholar 

  17. Goede AC, Reeves A, Dixon AR (2011) Laparoscopic procto-colectomy: a 10-year experience of an evolving technique. Colorectal Dis. doi:10.1111/j.1463-1318.2010.02443.x

  18. Zafar N, Davies R, Greenslade GL, Dixon AR (2010) The evolution of analgesia in an “accelerated” recovery programme for resectional laparoscopic colorectal surgery with anastomosis. Colorectal Dis 12:119–124

    Article  PubMed  CAS  Google Scholar 

  19. Rickard MJ, Young CJ, Bissett IP, Stitz R, Soloman MJ, Research committee of the Colorectal Surgical Society of Australasia (2007) Ileal pouch-anal anastomosis: the Australasian experience. Colorectal Dis 9:139–145

    Article  PubMed  CAS  Google Scholar 

  20. Larson DW, Davies MM, Dozois EJ, Cima RR, Piotrowicz K, Anderson K, Barnes SA, Harmsen WS, Young-Fadok TM, Wolf BG, Pemberton JH (2008) Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis. Dis Colon Rectum 51:392–396

    Article  PubMed  Google Scholar 

  21. Dalton SJ, Ghosh A, Greenslade GL, Dixon AR (2011) Laparoscopic colorectal surgery—why would you not want to have it and more importantly, not be trained in it? A consecutive series of 500 elective resections with anastomosis. Colorectal Dis 13(2):144–149

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Mr. A. Goede was an Ethicon-sponsored laparoscopic colorectal fellow for 6 months while working at Frenchay Hospital. Miss K. Gash, Dr. B. Kaldowski, Dr. B. Vestweber, and Mr. Antony Dixon have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK

    K. J. Gash, A. C. Goede & A. R. Dixon

  2. The Bristol Clinic, Bristol, UK

    K. J. Gash, A. C. Goede & A. R. Dixon

  3. Department of General, Visceral & Thorax Surgery, Klinikum Leverkusen, Leverkusen, Germany

    B. Kaldowski & B. Vestweber

Authors
  1. K. J. Gash
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  2. A. C. Goede
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  3. B. Kaldowski
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  4. B. Vestweber
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  5. A. R. Dixon
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Corresponding author

Correspondence to A. R. Dixon.

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Gash, K.J., Goede, A.C., Kaldowski, B. et al. Single incision laparoscopic (SILS) restorative proctocolectomy with ileal pouch-anal anastomosis. Surg Endosc 25, 3877–3880 (2011). https://doi.org/10.1007/s00464-011-1814-y

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  • DOI: https://doi.org/10.1007/s00464-011-1814-y

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