Leonardo C Duraes, MD, PhD1, Tracy L Hull2, Luca Stocchi, MD2, Scott R Steele, MD, PhD2, Conor P Delaney, MD, PhD2, Mariane Camargo2, Emre Gorgun2, Hermann Kessler2. 1Johns Hopkins, 2Cleveland Clinic Foundation
Background: Although laparoscopic colorectal resections have been associated with lower risks of wound-related complications when compared with open resections, they still have a 10.3–22.7% rate of surgical site infection and a 6.0–10.8% incisional hernia risk. To date, one method to reduce wound complications is natural orifice specimen extraction (NOSE). Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional outcomes. In Crohn’s disease, the use of the anus as an extraction site also avoids mini-laparotomy to remove the specimen after proctectomy. However, these patients are at higher risk for perineal complications. The implications of transanal specimen extraction during laparoscopic surgery for Crohn’s disease have not been clearly delineated.
Methods: An institutional database was queried to identify patients undergoing laparoscopic total proctocolectomy for Crohn’s disease between 1995 and 2013, in whom the specimen was extracted transanally. Perioperative outcomes were assessed.
Results: Thirty-four patients were identified (16 total proctocolectomies and 8 completion proctectomies). The mean age of patients was 42.6 years. Nineteen patients (79%) had previous abdominal operations. Most patients were female (63%). Four patients underwent robotic procedure (1 total proctocolectomy and 3 completion proctectomies), 3 patients underwent single-port procedure (3 completion proctectomies), and 1 patient underwent hand-assisted laparoscopic surgery (total proctocolectomy). Eight patients had perianal Crohn’s disease. The median length of hospital stay was 6 days. Six patients were readmitted, and 4 patients were reoperated within 30 days (2 pelvic septic complications, 1 inadvertent enterotomy, and 1 perineal debridement). Two patients had perineal wound infections with delayed healing. No abdominal wound complications were observed.
Conclusion: Natural orifice specimen extraction during laparoscopic surgery for Crohn’s colitis is safely feasible and may be considered despite higher risk for perineal challenges in patients with Crohn’s disease.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95261
Program Number: P315
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster