Saeed Shoar1, Alberto Gonzale, Dr2, Sergio H Ibarra2, Jean-Paul LeFave1, Eric M Haas, Professor3. 1Colorectal Surgical Associates, Houston, Texas, 2Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School, Houston, TX, USA, 3Houston Methodist Hospital, Houston, Texas
Introductions: Single incision laparoscopic surgery (SILS) has earned interest for colorectal diseases. Most studies report the port placement to be at the umbilicus which carries a high rate of incisional hernia and is suboptimal when direct exposure to the anastomosis is required. The aim of this study is to investigate the success rate and peri-operative outcomes of patients with diverticulitis undergoing resection using SILS technique through a pfannesteil incision.
Methods and procedures: Between September 2009 and May 2016, a total of 212 consecutive patients underwent elective resection for diverticulitis using SILS approach. In all patients, SILS was performed through a 4-cm pfannestieal incision for placement of the single port device. An additional 5 mm port (SILS +1) was placed in the umbilical for a camera port per surgeons preference. Patient outcomes were followed for a median of 28 months (range between 1 and 30 months). Short and long-term analysis was performed for peri-operative outcomes.
Results: Of a total of 212 diverticulitis patients undergoing CRS, 100 were male (47.2%) and 121 female (52.8%) with an average age, BMI and ASA of 57.85±11.9 years, 27.7±4.6 kg/m2 and 2.3±0.5, respectively. All patients had successful resection except one (0.4%) who required colostomy due to unexpected severity of disease. Surgical approach was SILS in 54 patients (25.5%) and SILS+1 in 158 patients (74.5%). Conversion was necessary in 6 patients (2.4%). The mean OR time was 189±60.5 min and the average estimated blood loss (EBL) was 76.9±89.2 ml. Mean hospital length of stay was 4 days (range 1-51). Nine patients (4.2%) required readmission within the 1st postoperative month and 5 patients (2.4%) required re-operative intervention. Major postoperative complications occurred in 21 patients (9.9%) with surgical site infection (3.3%) and ileus (1.5%) as the two most prevalent. There was no mortality during the follow-up period. Factors that contributed to the increased length of stay and morbidity included elderly patients and those with greater BMI. One patient (0.4%) in the cohort developed recurrent diverticulitis located in the left colon. No patients developed an incisional hernia.
Conclusion: SILS surgery is a safe and feasible approach for diverticulitis. When performed though a fpannesteil incision, there is a low rate of recurrent and avoidance of post-op hernias. Elderly and those with higher BMI face a slightly higher length of stay and morbidly risk.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80665
Program Number: S139
Presentation Session: Colorectal 2
Presentation Type: Podium