Rodrigo Pedraza, MD1, Sergio Ibarra, MD2, Alberto Gonzalez-Almada, MD2, Eric M Haas, MD, FACS, FASCRS3. 1Department of Surgery, Houston Methodist Hospital, 2Colorectal Surgical Associates, 3Chair, Division of Colorectal Surgery, Department of Surgery, Houston Methodist Hospital
Background: Total proctocolectomy (TPC) with ileal J pouch-anal anastomosis (IPAA) is considered one of the most challenging colorectal surgical procedures. While most TPC with IPAA are performed with open surgery, minimally invasive approaches such as multiport, hand-assisted, and robotic-assisted laparoscopy have been described. We adopted single-incision laparoscopic (SIL) TPC with IPAA as our preferred approach, since it utilizes the ileostomy site as the location for the single-port in which the entirety of the procure can be accomplished. We present, to our knowledge, the largest series of TPC with IPAA for chronic ulcerative colitis (CUC) performed utilizing SIL technique
Methods: The data were obtained from an IRB-approved prospectively maintained database. From June 2012 to September 2016, consecutive patients with CUC who underwent planned TPC with IPAA in were analyzed. All procedures were performed by a single surgeon (EMH) utilizing SIL approach. The single port device was placed though the ileostomy site in which the camera and instruments were placed to accomplish the procedure.
Results: During the study period, a total of 24 patients had CUC and underwent SIL TPC and IPAA. The median age, ASA, and BMI were 35, 2, and 23.8, respectively. Just over half were female (n=13, 54.2%). The median OT and EBL were 249 minutes and 50 mL, respectively. The success rate of the IPAA was 100%. No cases required terminal vessels division or peritoneal scoring as a lengthening maneuver. None of the cases required open conversion and 10 cases necessitated one additional 5 mm trocar. The median LOS was 3 days (range 2-6) and all but 3 patents were discharged within 4 days (87.5%). There were 6 postoperative complications (25.0%), 5 readmissions (20.8%), and 1 re-operation (4.2%) for closed loop small bowel obstruction. There were no anastomotic leaks.
Conclusions: SIL TPC with IPAA is a safe and feasible minimally invasive approach for CUC. This technique has a high success rate and results in favorable short-term outcomes. By utilizing the ostomy for all ports as specimen extraction, this approach avoids port site incisions and specimen extraction incision and therefore has the potential to reduce surgical site infection rates, postoperative pain, and hernia formation. Comparative analysis will be warranted to evaluate benefits and limitations of this approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79377
Program Number: P235
Presentation Session: Poster (Non CME)
Presentation Type: Poster