David J Berler, MD, Riley K Kitamura, MD, Daniel A Popowich, MD, FACS, FACRS. Icahn School of Medicine at Mount Sinai
This is the case of a 23-year-old woman who presented with five years of constipation refractory to biofeedback and medications. She was found on workup consisting of an intestinal motility study, anorectal manometry, and MR defecography to have a diagnosis of colonic inertia. Colonoscopy was normal. The patient was brought for single incision laparoscopic subtotal colectomy with ileorectal anastomosis, through a suprapubic incision, the video of which is included. She did well postoperatively, with regular, daily bowel movements, improved anxiety pertaining to her bowel habits, and a resulting scar that could be hidden easily.
While single incision laparoscopic colectomy (SILC) has been well-described and accepted as feasible and safe, the approach has typically been through the midline. Our case demonstrates that SILC through a Pfannenstiel incision is both safe and, although challenging, ergonomically feasible in an appropriately selected patient. Should the patient’s body habitus be of substantial length, such that the splenic or hepatic flexures are excessively distant from the suprapubic port (thereby rendering their mobilization difficult), an additional five-millimeter working port may be placed.
A suprapubic approach may confer a lower risk for incisional hernia at the extraction site when compared through SILC through a midline incision. Furthermore, such an approach yields an improved cosmetic result. Such benefits are of the utmost importance when considering the population typically affected by this disease process.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87927
Program Number: V025
Presentation Session: Colorectal 1 Session
Presentation Type: Video
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