Reduced port versus conventional laparoscopic total proctocolectomy and ileal J pouch-anal anastomosis.
BACKGROUND
The feasibility and safety of single-incision laparoscopic total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) were first reported in 2010. To improve accuracy and efficiency while maintaining the cosmetic advantages of single-incision laparoscopic surgery, we have since modified the technique to include the use of a 5-mm instrument placed through the eventual drain site. The aim of this study is to compare reduced port laparoscopic (RPL) IPAA with conventional laparoscopic IPAA with respect to short-term outcomes to assess safety.


METHODS
RPL cases were matched to conventional laparoscopy cases for patient age (±5 years), body mass index, gender, diagnosis, type and number of stages of surgical procedure, American Society of Anesthesiologists (ASA) classification, and year of surgery (±3 years). Groups were compared using χ(2) or Fisher exact tests for categorical and Wilcoxon rank-sum test for quantitative data.


RESULTS
Twenty-four RPL patients were case-matched to an equal number of patients who underwent conventional laparoscopic IPAA. Short-term outcomes including postoperative complications, length of hospital stay, and time to first bowel movement were similar between groups. Despite similar diagnosis, previous surgery, and comorbidity, operative blood loss (p < 0.001) and operating time (p = 0.02) were lower for the RPL group.


CONCLUSIONS
RPL IPAA can be safely performed with short-term outcomes comparable to conventional laparoscopy.
Department of Colorectal Surgery, Digestive Disease Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA. costedm@ccf.org
Meagan M
MM
Costedio
Erman
E
Aytac
Emre
E
Gorgun
Ravi P
RP
Kiran
Feza H
FH
Remzi
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies