Ismail Hamzaoglu, MD, Bilgi Baca, MD, Eren Esen, MD, Erman Aytac, MD, Volkan Ozben, MD, Afag Aghayeva, MD, Ilknur Erenler Bayraktar, MD, Tayfun Karahasanoglu, MD. Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine
Introduction: Total and completion robotic restorative proctocolectomy with ileal J-pouch anal anastomosis (RRP-IPAA) for ulcerative colitis (UC) is an emerging technique which requires advanced technical setup and operative dexterity to perform pelvic and multi quadrant surgery. In this study, we present our initial experience on RRP-IPAA.
Materials and Methods: Patients undergoing total and completion RRP-IPAA between January 2015-July 2017 were included. The da-Vinci Xi® was used for the operations. Age, gender, body mass index (BMI), ASA score, indication for surgery, urgency of procedure, type of procedure, docking number, operation time, estimated blood loss, complications, short (≤30 days) and long term (>30 days) complications were evaluated.
Results: 19 patients (7 females) were included. Median age was 28. Median BMI was 23, median ASA score was 2. Total and completion RRP-IPAA were performed for 9 and 10 patients respectively. The indications were as follows: medical refractory UC (n=12), cancer/dysplasia (n=2), fulminant colitis (n=2), toxic megacolon (n=1), medical treatment resulting in growth retardation (n=1), medical treatment refractory bleeding (n=1). 1 patient with toxic megacolon had an emergent operation. The median docking number was 1 and 3 for completion and total RRP-IPAA respectively. Median operative time was 330 minutes. Median blood loss was 100 ml. All patients had a stapled ileal J pouch anal anastomosis. All patients had a diverting loop ileostomy at the time of IPAA creation. No intraoperative complications were observed. No conversion to open surgery was needed. The median time to flatus was 1 day. The median time to oral intake was 1 day. 1 patient had a laparotomy on postoperative day 12 due to intra-abdominal bleeding. 1 patient had a bleeding from ileostomy which was treated endoscopically. Superficial surgical site infection was observed in 3 patients. 1 patient had a pouchitis managed with oral antibiotics. 1 patient had an ileus responded to conservative treatment. 1 patient had a per-anal bleeding stopped spontaneously. 1 patient had a urinary tract infection responded to antibiotics. 2 patients had pouchitis, 1 patient had a perianal fistula requiring a loop ileostomy and a parastomal hernia was developed in another patient in long term follow up. No mortality was observed during the study period.
Conclusions: Our experience reveals that total or completion RRP-IPAA is a safe and feasible option for surgical treatment of UC. The Xi platform facilitates multi quadrant surgery and enables to perform a total restorative proctocolectomy in the same setting.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88580
Program Number: P808
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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