title: Single-port versus multiport laparoscopic ileocecal resection for Crohn's disease.
abstract: OBJECTIVE
  Several case series have demonstrated the feasibility of single-port laparoscopic ileocecal resection in Crohn's disease. However, only a few studies compared the single-port with a multiport laparoscopic ileocecal approach. The aim of this study was to compare short term surgical outcome parameters between single-port and multiport laparoscopic ileocecal resections for Crohn's disease.
  
  
  METHODS
  Twenty-one patients who underwent single-port laparoscopic ileocecal resection between March 2010 and September 2012 were prospectively registered. A matched comparison on a 1:2 basis was performed with patients who underwent multiport laparoscopic ileocecal resection from January 1999 to March 2010. Matching parameters were BMI, length of diseased bowel resected and the presence of fistulas. Endpoints were the length of postoperative hospital stay, operative time, conversions, complications, postoperative pain scores and postoperative analgesia consumption.
  
  
  RESULTS
  Twenty-one patients undergoing single-port resection were matched to 42 patients undergoing multiport resection. The postoperative stay (4 days, iqr 4-5 vs. 5 days, iqr 4-6; p=0.033), operative time (103 min, iqr 94.0-121.0 vs. 123.5 min, iqr 100.0-157.0; p=0.036) and morphine use on the first postoperative day (12.5 mg, iqr 5.0-33.3 vs. 28 mg, 15.0-50.0; p=0.012) differed significantly. Postoperative pain scores and complications were similar in both groups. This study was limited by potential selection bias.
  
  
  CONCLUSIONS
  Single-port laparoscopic ileocecal resection is safe and feasible in Crohn's disease and is associated with less need for pain medication postoperatively as opposed to multiport laparoscopic ileocecal resection.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: t.j.gardenbroek@amc.uva.nl.
authors.forename: Tjibbe J
authors.initials: TJ
authors.lastname: Gardenbroek
authors.forename: Tessa
authors.initials: T
authors.lastname: Verlaan
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
authors.forename: Geert R A M
authors.initials: GR
authors.lastname: D'Haens
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Buskens
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002432:Cecum / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Crohn's disease; ECCO; ERAS; European Crohn's and Colitis Organisation; HALS; Ileocecal resection; Inflammatory bowel diseases; Laparoscopy; ML-ICR; PCA; SP-ICR; Single-incision; Single-port; VAS; enhanced recovery after surgery.; hand-assisted laparoscopic surgery; interquartile range; iqr; multiport laparoscopic ileocecal resection; patient controlled analgesia; single port laparoscopic ileocecal resection; visual analogue scale