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Single-Incision Total Proctocolectomy and Ileal Pouch Anal Anastomosis in Pediatric Patients: Lessons Learned
Avraham Schlager1, Ragavan V Siddharthan1, Matthew T Santore1
11 Department of Pediatric Surgery, Emory University , Atlanta, Georgia .
Insights
Single-site total proctocolectomy with ileal pouch anal anastomosis (TPC-IPAA) is a safe and feasible approach for ulcerative colitis. Specific technical adaptations enhance the efficiency of this minimally invasive surgical technique.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) are standard treatments for medically refractory ulcerative colitis.
- Single-site surgery offers potential advantages in minimally invasive procedures.
Purpose of the Study:
- To demonstrate a single-site surgical approach for TPC-IPAA.
- To identify maneuvers that improve the efficiency of single-site TPC-IPAA.
Main Methods:
- Retrospective review of patients undergoing single-site three-stage TPC-IPAA for ulcerative colitis.
- Outcomes assessed included operative time, conversion rates, recovery milestones, complications, and length of stay.
- The GelPOINT Advanced Access Platform was utilized.
Main Results:
- Eight patients underwent single-site TPC-IPAA.
- Mean operative times were 242 minutes for total abdominal colectomy and 283 minutes for proctectomy/IPAA.
- Recovery was generally rapid with low complication rates (one per stage).
Conclusions:
- Single-site TPC-IPAA is a feasible and safe surgical option.
- Incorporating specific technical adaptations can enhance procedural efficiency.
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.
Materials And 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.
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