Re-operation surgery following IPAA: is there a role for laparoscopy?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Ileal J pouch anal anastomosis (IPAA) is standard for ulcerative colitis and familial adenomatous polyposis.
• Re-operative IPAA procedures are complex and typically performed at specialized centers.
• Limited data exists on laparoscopic re-operative IPAA surgery.

Purpose of the Study:

• To assess the safety and feasibility of a laparoscopic approach for re-operative trans-abdominal IPAA.
• To compare outcomes of laparoscopic versus open re-operative IPAA.

Main Methods:

• Retrospective analysis of a prospective database (2011-2018) of patients undergoing trans-abdominal re-operative IPAA.
• Classification of re-operations into pouch excision, revision, or advancement.
• Categorization of surgical approach: laparoscopic, converted to open, or open.

Main Results:

• 19 patients underwent attempted laparoscopic IPAA (63% success rate); 57 had open surgery.
• Laparoscopic IPAA significantly reduced length of stay (5.5 vs 9.7 days) and surgical site infections (0% vs 18% superficial, 0% vs 17% deep).
• No significant differences in overall complications, re-admission, re-operation, or mortality between groups.

Conclusions:

• Laparoscopic re-operative trans-abdominal IPAA is feasible and safe.
• Laparoscopic approach offers benefits in reduced length of stay and surgical site infections.
• This technique should be performed by highly experienced, high-volume laparoscopic surgeons.