SILS v SILS+1: a Case-Matched Comparison for Colorectal Surgery.
BACKGROUND
Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS has comparable or improved outcomes compared to multiport laparoscopy but technical limitations when operating in the pelvis. To address these limitations, we developed an innovative SILS+1 approach using a single Pfannenstiel incision for pelvis access with one additional umbilical port. Our goal was to compare outcomes for SILS and SILS+1 in lower abdominal and pelvic colorectal surgery.


METHODS
Review of a prospectively maintained database identified patients who underwent an elective reduced port laparoscopic lower abdominal/pelvic colorectal procedure from 2009 to 2014. Cases were stratified by approach: SILS versus SILS+1 then matched 1:2 on age, gender, body mass index (BMI), comorbidity, and procedure. Demographic, perioperative, and postoperative outcome variables were evaluated. The main outcome measures were operative time, conversion rate, length of stay, complication, morbidity, and mortality rates.


RESULTS
One hundred thirty-two reduced port AR/LAR patients were evaluated-44 SILS and 88 SILS+1. The groups were similar in age, gender, BMI, and ASA class. The primary diagnosis in both cohorts was diverticulitis (90.9 % SILS, 87.5 % SILS+1), and main procedure performed an anterior rectosigmoidectomy (86.4 % SILS, 88.2 % SILS+1). Significantly more SILS+1 patients had previous abdominal surgery (p = 0.01). The operative time was significantly shorter in SILS+1 (mean 166.6 [SD 48.4] vs. 178.0 [SD 70.0], p = 0.03). The conversion rate to multiport or open surgery was also significantly lower with SILS+1 compared to SILS (1.1 vs. 11.4 %, p = 0.02). Postoperatively, the length of stay across the groups was similar. SILS trended towards higher complication and readmission rates (NS). There were no unplanned reoperations or mortality in either group.


CONCLUSIONS
SILS+1 facilitates pelvic and lower abdominal colorectal surgery, with shorter operative times and lower conversion rates. The additional port improved visualization and outcomes without any impact on length of stay, readmission, or complication rates.
Colorectal Surgical Associates, Houston, TX, USA. debby_keller@hotmail.com.
Deborah S
DS
Keller
Colorectal Surgical Associates, Houston, TX, USA.
Juan R
JR
Flores-Gonzalez
Colorectal Surgical Associates, Houston, TX, USA.
Jaideep
J
Sandhu
Colorectal Surgical Associates, Houston, TX, USA.
Sergio
S
Ibarra
Colorectal Surgical Associates, Houston, TX, USA.
Nisreen
N
Madhoun
Colorectal Surgical Associates, Houston, TX, USA. ehaasmd@houstoncolon.com.|Houston Methodist Hospital, Houston, TX, USA. ehaasmd@houstoncolon.com.|Minimally Invasive Colorectal Surgery, University of Texas Medical School, Houston, TX, USA. ehaasmd@houstoncolon.com.
Eric M
EM
Haas
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery*; D061887:Conversion to Open Surgery; D004238:Diverticulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
Healthcare outcomes; Laparoscopic colorectal surgery; Reduced port surgery; Single-incision laparoscopic surgery