Reduced Port Versus Conventional Laparoscopic Total Proctocolectomy and Ileal J Pouch-Anal Anastomosis: A Case Matched Study

Meagan Costedio, Erman Aytac, Emre Gorgun, Ravi P Kiran, Feza Remzi. Department of Colorectal Surgery, Digestive Disease Institute, The Cleveland Clinic Foundation, OH, USA

 

Introduction: Our institution first reported the feasibility and safety of single-incision (SILS) laparoscopic total proctocolectomy and ileal pouch anal anastomosis (TPC/IPAA). In order to improve efficiency while maintaining the cosmetic advantages of SILS even for such technically complex procedures as TPC/IPAA, we have since modified the technique to include the use of a 5mm instrument for retraction placed through the eventual drain site, making this a reduced port technique. The aim of this study was to compare our reduced port laparoscopic (RPL) IPAA with conventional laparoscopic IPAA with respect to short-term outcomes.

Methods: RPL cases were computer-matched to conventional laparocopy cases for patient age (±5 years), body mass index, gender, diagnosis, type and number of stages of surgical procedure, American Society of Anesthesiologists (ASA) classification, and year of surgery (±3 years). Groups were compared with chi-square or Fisher exact tests for categorical and Wilcoxon rank sum test for quantitative data.

Results: 24 RPL patients were case-matched to an equal number of patients who underwent conventional laparoscopic IPAA. The two groups were well-matched for the chosen characteristics (Table 1). Short term outcomes including postoperative complications, length of hospital stay and time to bowel movement were similar between groups. Despite similar diagnosis, previous surgery and comorbidity, operative blood loss (p=0.0001) and operating time (p=0.0215) were significantly lower for the RPL group (Table 1).

Conclusion: RPL IPAA can be performed with comparative short term outcomes as conventional laparoscopy. Further, when performed by surgeons well trained in the laparoscopic technique, RPL IPAA may potentially be associated with intraoperative advantages such as shorter operating time and lower blood loss.
 

Table 1
  Reduced port laparoscopy
(n=24)
 
Conventional laparoscopy
(n=24)
 
P value
Age (year) 43.2±12.5 42.3±12.7 0.8527
BMI (kg/m2) 24.8±4.8 25.3±4.3 0.3223
Gender (F/M) 15/9 14/10 1.000
Completion Proctectomy(n) 11 11 1.000
TPC IPAA(n) 13 13 1.000
Ulcerative colitis(n) 23 22 1.000
FAP(n) 1 2 1.000
OBL (cc) 95.8±65 241.7±135.5 0.0001
OR time (min) 125.9±39.3 230±117.4 0.0215
LoH (day) 6.08±4.2 6.3±3.1 0.5989
BM (day) 1.9±1.06 2.04±1.7 0.8467
Readmission (n) 3 3 1.000
Conversion to open(n) 0 2 0.4894
Reoperation (n) 0 2 0.4894
Wound infection (n) 1 4 0.3475
Leak (n) 1 1 1.000

OBL: Operative blood loss; LoH: Length of hospital stay; BM: bowel movement; OR time: operating time; FAP: Familial adenomatous polyposis; TPC IPAA: Total proctocolectomy with ileal pouch anal anastomosis
 


Session Number: SS16 – SILS
Program Number: S092

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