Katherine Hrebinko, David Chessin, MD, Stephen Gorfine, MD, Joel Bauer, MD, Daniel Popowich, MD. Mount Sinai Hospital
Purpose: Total abdominal colectomy (TAC) is the definitive treatment for patients with severe acute ulcerative colitis (saUC) and has historically been performed in an open (OS) fashion. Minimally invasive approaches (MIS) are standard for many colorectal procedures. Reduced port laparoscopic surgery (SILS+1) is a variation of traditional laparoscopy (LS) to reduce incisions, post-operative pain, and facilitate a faster recovery. The objective of this study is to determine if the SILS+1 approach in patients with saUC is comparable to OS and LS approaches.
Methods: Consecutive saUC patients undergoing emergency TAC by four surgeons at a single academic institution from 2007-2016 were included. LS was defined as standard multiport where the extraction site was either the ileostomy aperture or pfannenstiel. For SILS+1, an access system was placed in the ileostomy aperture with a 5mm port in the LLQ. The extraction site was the ileostomy aperture. 61 patients met criteria (22 OS, 27 LS, 12 SILS+1). 58 patients subsequently underwent IPAA (37 OS, 8 LS, 13 SILS+1).
Results: There were no differences in patient age, sex, pre-operative labs/medications, duration/extent of disease, conversion to open surgery, or time to IPAA between groups. There were no differences in operative times (135.55 OS, 178.37 LS, 147.92 SILS+1), LOS (7.91 OS, 7.78 LS, 8.08 SILS+1), SBO, readmission or re-operation between groups. There was less EBL in SILS+1 compared to OS (356.25 OS, 54.44 SILS+1, p = 0.034). There was a higher rate of intra-abdominal abscess in SILS+1 (0% OS, 7% LS, 25% SILS+1, p=0.039). However, one SILS+1 patient suffered iatrogenic colonic perforation during extraction leading to an unfavorably long LOS and infectious complications. Excluding this outlier, SILS+1 fared comparatively to OS and LS.
For IPAA, there was less EBL in SILS+1 compared to OS (250 OS, 68.5 SILS, p<.001) and no difference in operative time or post-operative complications. LOS after IPAA was longer for OS compared to LS and SILS+1. There was no difference in LOS between LS and SILS+1 (8.19 OS, 5.25 LS, 6 SILS, p=0.023).
Conclusions: Early outcomes with SILS+1 show that this technique can be performed safely in patients with saUC and may yield benefits over open surgery, including decreased EBL, shorter LOS, and increased likelihood of subsequently undergoing MIS IPAA surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80507
Program Number: P265
Presentation Session: Poster (Non CME)
Presentation Type: Poster
