title: Alternative specimen extraction techniques after laparoscopic emergency colectomy in inflammatory bowel disease.
abstract: BACKGROUND
  Omitting the extraction site incision potentially further decreases the abdominal wall trauma in laparoscopic surgery. The purpose of this study was to report the results of alternative specimen extraction techniques after laparoscopic emergency colectomy in patients with inflammatory bowel disease (IBD).
  
  
  METHODS
  Ten consecutive patients with IBD underwent (sub)acute emergency colectomy for refractory disease from October 2009 until December 2010. The specimen was retrieved via the stoma site in three and transrectally in seven patients. Patient data were prospectively collected. In case of later completion proctectomy and pouch procedure, adhesions were systematically scored.
  
  
  RESULTS
  The extraction techniques were all feasible. Median operative time was 219 (interquartile range (IQR), 197-232) min. The pain scores and morphine requirement in patients decreased quickly after surgery. No infectious complications occurred. In five patients, a completion proctectomy was performed at a median time of 7 (IQR, 3.8-9.3) months after colectomy. All patients showed absence of any adhesions in the pelvis. In two patients, limited adhesions of the cut side of the mesentery were present.
  
  
  CONCLUSIONS
  Specimen extraction via the rectum or stoma site is a safe, alternative way to extract the specimen after laparoscopic colectomy. No infectious complications were observed postoperatively and no pelvic adhesions were found during completion proctectomy.
authors: Department of Surgery, Academic Medical Center, G4-146.1, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors: Tjibbe J
authors: TJ
authors: Gardenbroek
authors: Emma J
authors: EJ
authors: Eshuis
authors: Gijs J D
authors: GJ
authors: van Acker
authors: Pieter J
authors: PJ
authors: Tanis
authors: Willem A
authors: WA
authors: Bemelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003082:Colectomy / Q000379:methods*; D039021:Colonic Pouches; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D016737:Proctocolectomy, Restorative / Q000379:methods; D011446:Prospective Studies; D012086:Reoperation; D013048:Specimen Handling / Q000379:methods*; D000267:Tissue Adhesions / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine