Single Access Laparoscopic Surgery (SALS) for Ileal Disease

Mohamed Moftah, Dr, John Burke, Dr, Ronan A Cahill, Dr. Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland


INTRODUCTION: To show the effectiveness and usefulness of Single Access Laparoscopic Surgery (SALS) in the management of benign and malignant diseases of the ileum in both the elective and urgent care setting.

PATIENTS AND METHODS: Consecutive, non-selected patients (one male and seven females) with ileal disease requiring surgery in our university hospital between October 2011 and July 2011. All had a computerised tomogram of abdomen and pelvis preoperatively as well as standard perioperative management (including thromboembolic prophylaxis and intravenous antibiotics). SALS operative access to the peritoneum was achieved via a single trans-umbilical incision and therefore a ‘surgical glove port’ constructed as our preferred single port device (this is created by the insertion of conventional disposable laparoscopic trocar sleeves into the fingers of a sterile surgical glove that has been stretched onto the outer ring of a standard wound protector-retractor). With the pneumoperitoneum established, a 30 degree 10 mm laparoscope was introduced to inspect the abdominal cavity along with two or three conventional straight rigid laparoscopic instruments. The relevant ileal loop was located, its mobility assessed and the procedure performed. For ileal resection or enterotomy, an extracorporeal anastomosis was performed after the site of pathology was withdrawn up to and through the wound protector in the incision. After anastomosis or closure of the enterotomy, the bowel is replaced into abdominal cavity, wound protector removed and layered closure of fascia and skin is performed.

RESULTS: Eight patients (seven males) had surgery by this access modality. The median (range) age of the patients was 53.5 (22 – 78) years and the median (range) body mass index was 26 (20.2-28) kg/m2. One patient had previously had open abdominal surgery. Procedures included ileal (n=3) or ileocaecal resection (n=2)(for Crohn’s disease, n=3, tuberculosis, n=1, and B-cell lymphoma, n=1) and ileal opening (for the purposes of loop ileostomy formation and ileotomy for extraction of an impacted gallstone ileus) as well as a tru-cut biopsy of ileal mesenteric mass (subsequently proven desmoid tumor). The median (range) operating room time was 65 (35-115) min and blood loss was minimal in each case. The median (range) hospital stay was 4 (2-7) days. The mean (range) incision length was 3 (2–5)cm. There were no difficulties in maintaining pneumoperitoneum throughout the procedure and there was no need for additional or converted access. After a mean follow-up of 8 there have been no wound infections, hernias or other postoperative complications.

CONCLUSIONS: These preliminary results showed that SALS is an efficient and safe modality for management of ileal disease with all the advantages of minimally access surgery without significant increase in operation time, theatre resource or patient morbidity.

Session Number: Poster – Poster Presentations
Program Number: P264
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