title: Single-incision laparoscopic ileal pouch-anal anastomosis in children--how does it compare to a laparoscopic-assisted approach?
abstract: BACKGROUND
  Although single-incision laparoscopic (SIL) ileal pouch-anal anastomosis (IPAA) has been shown to be feasible and safe, outcomes have not been compared with the standard laparoscopic-assisted (LA) procedures. The purpose of this study was to compare the two techniques in children with chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP).
  
  
  METHODS
  Children ≤ 18 years of age who underwent SIL and LA IPAA between 2000 and 2013 at our institution were identified. Patient information was obtained retrospectively from patients' medical records and compared between approaches. RESULTS for operative time and postoperative length of stay were stratified by number of stages (one, two, or three), and postoperative complications were stratified by diagnosis (CUC or FAP).
  
  
  RESULTS
  Children who underwent SIL IPAA (n=19) and LA IPAA (n=62) were not significantly different in age, gender, diagnosis, anti-tumor necrosis factor-α antibody use, staged approach, and stapled versus mucosectomy with hand-sewn anastomosis. SIL and LA IPAA had equivalent operative times for two- and three-stage procedures, but operative time for one-stage procedures was shorter with SIL (308 versus 355 minutes; P<.001). Median length of stay was shorter following SIL for all patients (4 versus 7 days; P<.001) and, specifically, for two-stage patients (4 versus 6 days; P=.009). There were no significant differences in complications between SIL and LA.
  
  
  CONCLUSIONS
  SIL IPAA is a safe alternative to LA IPAA for children with CUC or FAP and may reduce postoperative length of stay without affecting short-term postoperative morbidity. Additional studies are needed to determine if there are long-term benefits.
authors.affiliation: 1 Department of Surgery, Mayo Clinic , Rochester, Minnesota.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.forename: D Dean
authors.initials: DD
authors.lastname: Potter
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies