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Single-incision laparoscopic ileal pouch-anal anastomosis in children--how does it compare to a laparoscopic-assisted
Stephanie F Polites1, Abdalla E Zarroug, Christopher R Moir
11 Department of Surgery, Mayo Clinic , Rochester, Minnesota.
Insights
Single-incision laparoscopic ileal pouch-anal anastomosis (SIL IPAA) is a safe alternative to laparoscopic-assisted IPAA in children. SIL IPAA may reduce hospital stay without increasing complications for pediatric patients with chronic ulcerative colitis or familial adenomatous polyposis.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Minimally invasive surgery
Background:
- Single-incision laparoscopic (SIL) ileal pouch-anal anastomosis (IPAA) feasibility and safety are established.
- Outcomes of SIL IPAA have not been compared to standard laparoscopic-assisted (LA) IPAA.
- Comparison is needed for pediatric patients with chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP).
Purpose of the Study:
- To compare SIL IPAA and LA IPAA outcomes in pediatric patients.
- To evaluate operative time, length of stay, and complications.
- To assess differences based on diagnosis (CUC/FAP) and number of surgical stages.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) undergoing SIL or LA IPAA (2000-2013).
- Comparison of patient demographics, diagnoses, and surgical approaches.
- Analysis of operative time, postoperative length of stay, and complications stratified by stage and diagnosis.
Main Results:
- No significant differences in age, gender, diagnosis, or anastomosis technique between SIL (n=19) and LA (n=62) IPAA.
- SIL IPAA showed shorter operative time for one-stage procedures (308 vs. 355 minutes; P<.001).
- Median length of stay was significantly shorter for SIL IPAA (4 vs. 7 days; P<.001), particularly for two-stage procedures (4 vs. 6 days; P=.009).
- No significant differences in postoperative complications were observed between the two approaches.
Conclusions:
- SIL IPAA is a safe and viable alternative to LA IPAA in pediatric CUC and FAP patients.
- SIL IPAA may lead to a reduced postoperative length of stay.
- Further research is required to ascertain any long-term benefits of SIL IPAA.
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).
Subjects And 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.
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