Yozo Suzuki, MD, PhD, Masahisa Ohtsuka, MD, PhD, Manabu Mikamori, MD, PhD, Takuro Saito, MD, PhD, Kenta Furukawa, MD, PhD, Mitsunobu Imasato, MD, PhD, Kentaro Kishi, MD, PhD, Masahiro Tanemura, MD, PhD, Hiroki Akamatsu, MD, PhD. Osaka Police Hospital
BACKGROUND: Small bowel obstruction (SBO) has a variety of backgrounds and its operation procedure is often modified to meet the intraoperative requirements. Single incision laparoscopic surgery is a laparoscopic procedure which leaves a single small incision in navel, and has been reported to be less invasive than and as safe and efficient as the conventional multiport laparoscopic surgery. The role of SILS in the SBO operation has not been well studied.
OBJECTIVE: The aim of this study was to examine the perioperative outcome and feasibility of single incision ileus operation (SIL-IO).
METHODS: This is a retrospective study from a prospectively collected database. The investigation took place in a high-volume mutidiciplinary acute hospital in Japan. From July 2013 to June 2018. Patients who had operation for SBO caused by adhesion or strangulation were analyzed. Cancerous or perforated SBO, or intussusceptions were excluded.
RESULTS: Out of consecutive 70 patients, 31 patients were started with SIL-IO. The background of the patients who had SIL-IO was as follows; median age was 69 (range; 20-94) year-old, 14 (45%) were female, 26 (84%) were American Society of Anesthesia Performance Status 0 or 1, Preoperative diagnoses were adhesion in 12 (39%) and strangulation in 19 (61%), the first SBO episode in 17 (55%), the number of past abdominal operative history was 0 in 6 (19%) and one in 18 (58%). Severe adhesion was observed in 4 (13%). Operation mode was as follows; small bowel resection in 13 (42%), derotation in 5 (16%), adhesiolysis in 10 (32%), debanding in 3 (10%). Perioperative outcome was as follows; the median operation time was 108 (38-390) min, bleeding Volume was 0 (0-800mL), being completed by SILS in 23 (74%) and converted to OS in 8 (26%) (4; unable to detect responsible lesions, 2; difficult to perform procedure, 2; broad necrosis of intestine detected), intraoperative damage to organ occurred in 7 (serosal damage due to adhesiolysis). On univariate analysis, male (P=0.031), severe adhesion (P=0.016), and ASAPS>/=3 (P=0.011) were independent risk factors of conversion. On multivariate analysis, male (P=0.0097) and severe adhesion (P=0.025) were independent risk factors of conversiion.
CONCLUSIONS: SILS in selected patients is a reasonable option in SBO.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95971
Program Number: P475
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster