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Re-operation surgery following IPAA: is there a role for laparoscopy?

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Abstract

Background

Restorative proctocolectomy with ileal J pouch anal anastomosis (IPAA) has become the standard of care for mucosal ulcerative colitis and Familial Adenomatous Polyposis. Some patients require re-operation, including pouch revision, advancement, or excision. Re-operative procedures are technically demanding and usually performed only by experienced colorectal surgeons in a small number of referral centers. There is a paucity of data regarding feasibility, safety, and outcomes of laparoscopic re-operative IPAA surgery. This study aimed to determine the safety and feasibility of laparoscopic approach for re-operative IPAA, trans-abdominal surgery.

Methods

Retrospective analysis of IRB-approved prospective database for patients who underwent trans-abdominal re-operative IPAA from 2011 to 2018. Patient demographics and operative reports were reviewed to classify type of re-operation into pouch excision, revision, or advancement and further classify as laparoscopic, laparoscopic converted to open, or open surgery. Main outcome measures were post-operative morbidity and mortality.

Results

Seventy-six patients met the inclusion criteria: 19 underwent attempted laparoscopic re-operative IPAA surgery, 12 of whom underwent successful laparoscopic surgery while 7 were converted to laparotomy, for an overall laparoscopic intent to treat 63% success rate. The remaining operations (n = 57) were performed through midline laparotomy. Length of stay (LOS) for patients who underwent laparoscopic surgery was significantly shorter (5.5 vs 9.7 days, p < 0.001) as were abdominal superficial surgical site infections (SSI) (0% vs 18%, p < 0.001) and deep SSI (0% vs 17%, p < 0.001). Laparotomy was performed by 6 colorectal surgeons at our institution while laparoscopy was successfully performed only by the senior author. There was no significant difference in overall complications, re-admission, re-operation, or mortality.

Conclusion

Re-operative, trans-abdominal, laparoscopic IPAA is both feasible and safe and has clear benefits compared to laparotomy in terms of LOS and superficial and deep SSI. However, this approach needs to be undertaken only by very experienced, high-volume laparoscopic IPAA surgeons.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Shlomo Yellinek, Hayim Gilshtein, Dimitri Krizzuk & Steven D. Wexner

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  1. Shlomo Yellinek
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  2. Hayim Gilshtein
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  3. Dimitri Krizzuk
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  4. Steven D. Wexner
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Correspondence to Steven D. Wexner.

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Shlomo Yellinek, Hayim Gilshtein, Dimitri Krizzuk, and Steven D. Wexner have no conflicts of interest.

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Yellinek, S., Gilshtein, H., Krizzuk, D. et al. Re-operation surgery following IPAA: is there a role for laparoscopy?. Surg Endosc 35, 1591–1596 (2021). https://doi.org/10.1007/s00464-020-07537-0

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  • DOI: https://doi.org/10.1007/s00464-020-07537-0

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