Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2020; 26(39): 6015-6026
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6015
Single access laparoscopic total colectomy for severe refractory ulcerative colitis
John Burke, Des Toomey, Frank Reilly, Ronan Cahill
John Burke, Des Toomey, Frank Reilly, Department of Colorectal Surgery, Beaumont Hospital, Dublin D09, Ireland
Ronan Cahill, Department of Surgery, Mater Misericordiae University Hospital, Dublin D07, Ireland
Author contributions: All authors contributed substantially to this work; Cahill R was involved in study concept and design; Burke J, Toomey D and Reilly F were involved in data collection; all authors contributed to data analysis, manuscript drafting and approval.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at the Mater Misericordiae University Hospital Clinical Audit and Effectiveness Committee.
Conflict-of-interest statement: No author has a conflict of interest with regard to the subject of this work.
Data sharing statement: Data will be made available via the UCD data registry and also on request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ronan Cahill, FRCS, MBBAOBCh, MD, Professor, Department of Surgery, Mater Misericordiae University Hospital, 47 Eccles Street, Dublin D01, Ireland. ronan.cahill@ucd.ie
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: February 19, 2020
Revised: June 15, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: October 21, 2020
Processing time: 294 Days and 23.5 Hours
Abstract
BACKGROUND

Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision. While intuitively appealing, there is sparse evidence for its use beyond feasibility.

AIM

To examine the usefulness of single access laparoscopy (SAL) in a general series experience of patients sick with ulcerative colitis.

METHODS

All patients presenting electively, urgently or emergently over a three-year period under a colorectal specialist team were studied. SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a “surgical glove port” allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery. Standard, straight rigid laparoscopic instrumentation were used without additional resource.

RESULTS

Of 46 consecutive patients requiring surgery, 39 (85%) had their procedure begun laparoscopically. 27 (69%) of these were commenced by single port access with an 89% completion rate thereafter (three were concluded by multi-trocar laparoscopy). SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs (> 100€case) and postoperative hospital stay (median 5 d vs 7.5 d, P = 0.045) without increasing operative time. It proved especially efficient in those with preoperative albumin > 30 g/dL (n = 20). Its comparative advantages were further confirmed in ten pairs case-matched for gender, body mass index and preoperative albumin. SAL outcomes proved durable in the intermediate term (median follow-up = 20 mo).

CONCLUSION

Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis. Assumptions regarding duration and cost should not be barriers to its implementation.

Keywords: Single incision laparoscopy; Minimal access surgery; Inflammatory bowel disease; Ulcerative colitis; Total colectomy and end ileostomy; Case match analysis

Core Tip: Single access laparoscopy performed via the stoma site for patient’s sick with ulcerative colitis and needing total colectomy with ileostomy is shown to be appropriate and with some advantages over its multiport equivalent. Operative costs and total hospital stay were significantly reduced with the Single access laparoscopy approach (using a “glove port”) and outcomes were sustained in the intermediate term.