Single-Incision Total Proctocolectomy and Ileal Pouch Anal Anastomosis in Pediatric Patients: Lessons Learned.
BACKGROUND
Total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) have become the standard of care for patients with ulcerative colitis refractory to medical management. The purpose of our study is to show our single-site approach and to identify maneuvers that improve efficiency.


METHODS
We retrospectively reviewed patients who underwent single-site three-stage TPC-IPAA for ulcerative colitis at our institution. Primary outcomes included operative time, conversion from single site to standard laparoscopy, time to oral intake and stoma function, postoperative complications, and length of stay. The GelPOINT(™) Advanced Access Platform (Applied Medical, Santa Margarita, CA) was used.


RESULTS
Eight patients were identified who had undergone single-site surgery with the GelPOINT platform. Six of the 8 patients underwent the first stage, total abdominal colectomy (TAC), and all 8 underwent the second stage (proctectomy/IPAA). The mean operating time for TAC was 242 ± 32 minutes. The mean time until tolerance of clear diet was 1.2 ± 0.4 days, and time until tolerance of regular diet was 3.3 ± 1.2 days. The mean time to stoma function was 1.5 ± 0.55 days, and that for postoperative opioid use was 4.0 ± 1.3 days. The median length of stay was 5 days (range, 3-10 days). There was one postoperative complication. The mean operating time for the proctectomy/IPAA was 283 ± 50 minutes. The mean time until tolerance of clear diet was 1.0 ± 0.5 days, and time until tolerance of regular diet was 3.3 ± 1.1 days. The mean time to stoma function was 1.6 days ± 0.52 days, and that for postoperative opioid use was 3.3 ± 1.4 days. Median length of stay was 4 days (range, 3-9 days). There was one postoperative complication. Technical adaptations that included extracorporeal mesenteric division, rectal eversion, and rotation of the GelPOINT device served to improve the ease and efficiency of the procedure.


CONCLUSIONS
Single-site TPC-IPAA is both feasible and safe. Incorporation of adapted technical maneuvers can increase efficiency.
1 Department of Pediatric Surgery, Emory University , Atlanta, Georgia .
Avraham
A
Schlager
1 Department of Pediatric Surgery, Emory University , Atlanta, Georgia .
Ragavan V
RV
Siddharthan
1 Department of Pediatric Surgery, Emory University , Atlanta, Georgia .
Matthew T
MT
Santore
1 Department of Pediatric Surgery, Emory University , Atlanta, Georgia .
Ozlem
O
Balci
2 Department of Surgery, Emory University , Atlanta, Georgia .
Matthew S
MS
Clifton
1 Department of Pediatric Surgery, Emory University , Atlanta, Georgia .
Kurt F
KF
Heiss
D000293:Adolescent; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome