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  1. Article ; Online: Bowel seromuscular flaps used to repair pelvic defects in patients undergoing reoperative surgery.

    Bauzon, J S / Tran, N V / Hebert, B R / Mathis, K L

    Techniques in coloproctology

    2022  Volume 27, Issue 5, Page(s) 373–378

    Abstract: Background: Pedicled seromuscular bowel flaps may serve as an alternative for pelvic floor reconstruction when conventional omental and muscular flaps are not an option in patients undergoing reoperative abdominopelvic surgery. The aim of this study was ...

    Abstract Background: Pedicled seromuscular bowel flaps may serve as an alternative for pelvic floor reconstruction when conventional omental and muscular flaps are not an option in patients undergoing reoperative abdominopelvic surgery. The aim of this study was to evaluate a unique series of bowel seromuscular flaps used to obliterate intrapelvic defects.
    Methods: We conducted a retrospective study on all patients in a single tertiary care institutional database who had undergone pelvic reconstruction with a seromuscular bowel flap from January 2006 to December 2018. The primary outcomes measured were the 30-day morbidity and mortality rates.
    Results: Twelve patients (6 men 6 women, median age 56.5 years [range 33-77 years]) underwent reoperative abdominopelvic surgery requiring the use of a native small or large seromuscular bowel flap to obliterate pelvic defects. The indications for surgery included chronic infections, fistulizing Crohn's disease, and cancer. In all cases, no residual omentum was available and rectus abdominis muscle flaps were not feasible due to prior operative scars. Thirty-day morbidity occurred in 5 patients (42%), and included urine leak from ureteral injury, anastomotic leak, acute kidney injury, and superficial surgical site infection. No flaps became ischemic or required removal in the postoperative setting. No mortality was recorded.
    Conclusions: Bowel seromuscular flaps are a feasible and safe alternative for covering pelvic defects in patients who are undergoing reoperative surgery without the option to use traditional omental and muscular flaps.
    MeSH term(s) Male ; Humans ; Female ; Adult ; Middle Aged ; Aged ; Retrospective Studies ; Postoperative Complications/etiology ; Surgical Flaps ; Plastic Surgery Procedures ; Pelvis/surgery
    Language English
    Publishing date 2022-09-06
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02697-8
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    Zs.A 5842: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Robotic resection of presacral tumors.

    Ferrari, D / Violante, T / Addison, P / Perry, W R G / Merchea, A / Kelley, S R / Mathis, K L / Dozois, E J / Larson, D W

    Techniques in coloproctology

    2024  Volume 28, Issue 1, Page(s) 49

    Abstract: Background: Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of ... ...

    Abstract Background: Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors.
    Methods: This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates.
    Results: Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25-69 years). The median operative time was 197 min (range 98-802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1-6 days). The median follow-up was 6.7 months (range 1-110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant).
    Conclusions: Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.
    MeSH term(s) Humans ; Middle Aged ; Female ; Male ; Robotic Surgical Procedures/methods ; Adult ; Aged ; Retrospective Studies ; Operative Time ; Treatment Outcome ; Length of Stay/statistics & numerical data ; Margins of Excision ; Blood Loss, Surgical/statistics & numerical data ; Postoperative Complications/etiology ; Postoperative Complications/epidemiology ; Neoplasm Recurrence, Local/surgery ; Neoplasm Recurrence, Local/epidemiology ; Pelvic Neoplasms/surgery
    Language English
    Publishing date 2024-04-23
    Publishing country Italy
    Document type Journal Article ; Evaluation Study
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-024-02922-6
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  3. Article ; Online: A 25 year experience of perineal hernia repair.

    McKenna, N P / Habermann, E B / Larson, D W / Kelley, S R / Mathis, K L

    Hernia : the journal of hernias and abdominal wall surgery

    2019  Volume 24, Issue 2, Page(s) 273–278

    Abstract: Purpose: Though perineal hernias remain rare, the incidence is reportedly rising. Secondary to the historical rarity, optimal method of repair and outcomes after repair remain poorly understood. Therefore, we reviewed the past 25 years of our ... ...

    Abstract Purpose: Though perineal hernias remain rare, the incidence is reportedly rising. Secondary to the historical rarity, optimal method of repair and outcomes after repair remain poorly understood. Therefore, we reviewed the past 25 years of our institutional experience with perineal hernia repair.
    Methods: A retrospective review of an institution-maintained database was conducted from January 1, 1994 to January 31, 2018 for patients undergoing perineal hernia repair. Data were collected on patient characteristics, operative technique, and post-operative outcomes.
    Results: Twenty-one patients (n = 12 male) underwent perineal hernia repair in the study period with two-thirds of the operations occurring in the most recent 7 years (since January 1, 2011). The median time to repair was 13 months (range 2-127) after index operation. The approach was transabdominal in nine, perineal in nine, and combined in three. Mesh, a tissue flap, or a combination of these was used in 19 of the cases and 6 additional abdominal wall hernias were repaired concurrently. Post-operative complications consisted of superficial surgical-site infection (n = 2), infected seroma (n = 1), and a missed enterotomy (n = 1). Follow-up ranged from 0 to 112 months (median 2 months) and only one recurrence was noted.
    Conclusion: Presentation for repair of perineal hernia has increased at our instituion over the past 2 decades. Outcomes did not differ between the three repair approaches and the choice of mesh or tissue-based repair. Surgeons should base these decisions on hernia complexity and local tissue conditions.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Hernia, Abdominal/surgery ; Herniorrhaphy/methods ; Herniorrhaphy/statistics & numerical data ; Humans ; Male ; Middle Aged ; Perineum/surgery ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Flaps ; Surgical Mesh
    Language English
    Publishing date 2019-05-02
    Publishing country France
    Document type Journal Article
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-019-01958-0
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    Zs.A 5390: Show issues Location:
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  4. Article ; Online: Risk factors for conversion in laparoscopic and robotic rectal cancer surgery.

    Crippa, J / Grass, F / Achilli, P / Mathis, K L / Kelley, S R / Merchea, A / Colibaseanu, D T / Larson, D W

    The British journal of surgery

    2020  Volume 107, Issue 5, Page(s) 560–566

    Abstract: Background: The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery.: Methods: A retrospective analysis was performed of consecutive patients operated ... ...

    Abstract Background: The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery.
    Methods: A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m
    Results: A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non-obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71).
    Conclusion: Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non-obese patients.
    MeSH term(s) Adenocarcinoma/complications ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Aged ; Body Mass Index ; Conversion to Open Surgery ; Female ; Humans ; Intraoperative Complications ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Neoplasm Staging ; Obesity/complications ; Rectal Neoplasms/complications ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Reoperation ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/adverse effects ; Sex Factors
    Language English
    Publishing date 2020-01-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11435
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    Uk I Zs.66: Show issues Location:
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  5. Article ; Online: Identification of patients eligible for discharge within 48 h of colorectal resection.

    Grass, F / Hübner, M / Mathis, K L / Hahnloser, D / Dozois, E J / Kelley, S R / Demartines, N / Larson, D W

    The British journal of surgery

    2020  Volume 107, Issue 5, Page(s) 546–551

    Abstract: Background: This study aimed to identify patients eligible for a 48-h stay after colorectal resection, to provide guidance for early discharge planning.: Methods: A bi-institutional retrospective cohort study was undertaken of consecutive patients ... ...

    Abstract Background: This study aimed to identify patients eligible for a 48-h stay after colorectal resection, to provide guidance for early discharge planning.
    Methods: A bi-institutional retrospective cohort study was undertaken of consecutive patients undergoing major elective colorectal resection for benign or malignant pathology within a comprehensive enhanced recovery pathway between 2011 and 2017. Overall and severe (Clavien-Dindo grade IIIb or above) postoperative complication and readmission rates were compared between patients who were discharged within 48 h and those who had hospital stay of 48 h or more. Multinominal logistic regression analysis was performed to ascertain significant factors associated with a short hospital stay (less than 48 h).
    Results: In total, 686 of 5122 patients (13·4 per cent) were discharged within 48 h. Independent factors favouring a short hospital stay were age below 60 years (odds ratio (OR) 1·34; P = 0·002), ASA grade less than III (OR 1·42; P = 0·003), restrictive fluid management (less than 3000 ml on day of surgery: OR 1·46; P < 0·001), duration of surgery less than 180 min (OR 1·89; P < 0·001), minimally invasive approach (OR 1·92; P < 0·001) and wound contamination grade below III (OR 4·50; P < 0·001), whereas cancer diagnosis (OR 0·55; P < 0·001) and malnutrition (BMI below 18 kg/m
    Conclusion: Early discharge of selected patients is safe and does not increase postoperative morbidity or readmission rates. In these patients, outpatient colorectal surgery should be feasible on a large scale with logistical optimization.
    MeSH term(s) Age Factors ; Aged ; Colonic Diseases/surgery ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Digestive System Surgical Procedures/adverse effects ; Elective Surgical Procedures/adverse effects ; Female ; Fluid Therapy ; Humans ; Length of Stay ; Male ; Malnutrition/complications ; Middle Aged ; Minimally Invasive Surgical Procedures/adverse effects ; Neoplasm Grading ; Operative Time ; Patient Discharge ; Rectal Diseases/surgery ; Regression Analysis ; Retrospective Studies ; Surgical Wound Infection
    Language English
    Publishing date 2020-01-07
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11399
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  6. Article ; Online: Outcomes of Early Removal of Urinary Catheter Following Rectal Resection for Cancer.

    Duchalais, E / Larson, David W / Machairas, N / Mathis, K L / Dozois, E J / Kelley, S R

    Annals of surgical oncology

    2018  Volume 26, Issue 1, Page(s) 79–85

    Abstract: Purpose: Early postoperative urinary catheter removal decreases urinary tract infection (UTI) rate and accelerates patient mobilization. The aim of this study is to determine the results of systematic urinary catheter removal on postoperative day (POD) ... ...

    Abstract Purpose: Early postoperative urinary catheter removal decreases urinary tract infection (UTI) rate and accelerates patient mobilization. The aim of this study is to determine the results of systematic urinary catheter removal on postoperative day (POD) 1 in patients undergoing rectal resection for cancer.
    Patients and methods: Using a prospectively maintained database of 469 patients who underwent rectal resection for cancer, a retrospective review of all patients with urinary catheter removal on POD1 was conducted. Patients unable to void 6 h after catheter removal underwent in and out urinary catheterization (IOC group) and were compared with patients who voided spontaneously (non-IOC group) to determine risk factors for IOC.
    Results: A total of 417 patients were identified, including 274 (66%) men. Median age was 59 (50-68) years. Abdominoperineal resection (APR) was performed in 134 (32%), and complex surgery with resection of at least one other organ in 72 (17%) patients. Non-IOC and IOC groups included 245 (59%) and 172 (41%) patients, respectively. Five independent predictive factors for IOC were male gender, obesity, history of obstructive urinary disease, APR, and metastatic disease. The cumulative risk of IOC in patients with zero, one, two, and at least three risk factors was 8%, 31%, 52%, and 68% on POD1, and 2%, 12%, 23%, and 30% on POD5, respectively (p < 0.001). Thirteen patients (3%) developed UTI.
    Conclusions: Early removal of urinary catheter resulted in 59% of patients voiding spontaneously with no need for IOC following rectal resection. Patients without any predictive factors had less than 10% risk of urinary dysfunction.
    MeSH term(s) Aged ; Catheter-Related Infections/prevention & control ; Device Removal/standards ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications/prevention & control ; Prognosis ; Prospective Studies ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Urinary Catheterization/methods ; Urinary Tract Infections/prevention & control
    Language English
    Publishing date 2018-10-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-018-6822-x
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    Zs.A 4042: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  7. Article ; Online: Comparison of recovery and outcome after left and right colectomy.

    Grass, F / Lovely, J K / Crippa, J / Ansell, J / Hübner, M / Mathis, K L / Larson, D W

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2019  Volume 21, Issue 4, Page(s) 481–486

    Abstract: Aim: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies.: Method: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 ... ...

    Abstract Aim: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies.
    Method: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI).
    Results: In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m
    Conclusion: Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.
    MeSH term(s) Adult ; Aged ; Colectomy/adverse effects ; Colectomy/methods ; Colectomy/statistics & numerical data ; Crohn Disease/surgery ; Databases, Factual ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/methods ; Elective Surgical Procedures/statistics & numerical data ; Enhanced Recovery After Surgery ; Female ; Humans ; Ileus/epidemiology ; Ileus/etiology ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Period ; Prospective Studies ; Recovery of Function ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2019-01-18
    Publishing country England
    Document type Comparative Study ; Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.14543
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    Zs.A 5799: Show issues Location:
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  8. Article ; Online: Postoperative outcomes in vedolizumab-treated Crohn's disease patients undergoing major abdominal operations.

    Lightner, A L / McKenna, N P / Tse, C S / Raffals, L E / Loftus, E V / Mathis, K L

    Alimentary pharmacology & therapeutics

    2017  Volume 47, Issue 5, Page(s) 573–580

    Abstract: Background: Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post- ... ...

    Abstract Background: Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post-operative complications.
    Aim: We sought to compare 30-day postoperative infectious complication rate among vedolizumab-treated Crohn's disease patients vs those who had received TNFα inhibitors or no biologic therapy.
    Methods: A retrospective review of all Crohn's disease patients who received vedolizumab within 12 weeks of a major abdominal or pelvic operation was performed. Two control cohorts consisted of Crohn's disease patients treated with TNFα inhibitors or no biologic therapy.
    Results: One hundred Crohn's disease patients received vedolizumab within 12 weeks of an abdominal operation. Vedolizumab-treated patients underwent an equivalent rate of laparoscopic surgery (P = .25), had fewer anastomoses performed (P = .0002), and had equally frequent diversion in the setting of anastomoses (P = .47). Thirty-two vedolizumab-treated patients experienced postoperative infectious complications (32%), 26 of which were surgical site infections (26%). The vedolizumab-treated group experienced no difference in nonsurgical site infections (6% vs 5% anti-TNFα and 2% nonbiologic; P = .34), but significantly higher rates of surgical site infections (26% vs 8% and 11%; P < .001). On univariate and multivariate analysis, exposure to vedolizumab remained a significant predictor of postoperative surgical site infection (P < .001 and P = .002).
    Conclusions: Twenty-six per cent of Crohn's disease patients who received vedolizumab within 12 weeks prior to a major abdominal operation experienced a 30-day postoperative surgical site infection, significantly higher than that of patients receiving TNFα inhibitors or no biologic therapy. Vedolizumab within 12 weeks of surgery remained a predictor of 30-day postoperative surgical site infection on multivariable analysis. While vedolizumab-treated Crohn's disease patients may be a sicker cohort of patients, it is important to consider these findings with regard to preoperative counselling, operative timing and primary closure of wounds.
    MeSH term(s) Abdomen/surgery ; Adolescent ; Adult ; Aged ; Antibodies, Monoclonal, Humanized/therapeutic use ; Cohort Studies ; Crohn Disease/drug therapy ; Crohn Disease/epidemiology ; Crohn Disease/surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Period ; Retrospective Studies ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Treatment Outcome ; Young Adult
    Chemical Substances Antibodies, Monoclonal, Humanized ; vedolizumab (9RV78Q2002)
    Language English
    Publishing date 2017-12-18
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639012-2
    ISSN 1365-2036 ; 0269-2813 ; 0953-0673
    ISSN (online) 1365-2036
    ISSN 0269-2813 ; 0953-0673
    DOI 10.1111/apt.14459
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    Zs.A 2206: Show issues Location:
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  9. Article ; Online: Pouch excision: indications and outcomes.

    Lightner, A L / Dattani, S / Dozois, E J / Moncrief, S B / Pemberton, J H / Mathis, K L

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2017  Volume 19, Issue 10, Page(s) 912–916

    Abstract: Aim: Restorative proctocolectomy with ileal-pouch anal anastomosis is the procedure of choice for ulcerative colitis. Unfortunately, up to 10% of pouches will fail, requiring either reconstruction or excision. While several series have reported on the ... ...

    Abstract Aim: Restorative proctocolectomy with ileal-pouch anal anastomosis is the procedure of choice for ulcerative colitis. Unfortunately, up to 10% of pouches will fail, requiring either reconstruction or excision. While several series have reported on the aetiology of pouch failure, no study to date has focused on the postoperative complications associated with pouch excision.
    Methods: Patients who had excision of ileoanal reservoir with ileostomy (CPT code 45136) were included. Data abstracted included preoperative, operative and postoperative variables. A Kaplan-Meier curve of pouch survival was performed.
    Results: In all, 147 patients met the inclusion criteria for the study. The median age of patients was 47 years (73 women), and 132 had a diagnosis of ulcerative colitis at the time of colectomy. The most common indications for pouch excision were sepsis (n = 46; 31%) and Crohn's disease (n = 37; 25%). 84 (57%) patients experienced short-term (< 30 days) postoperative complications, the most common of which was a surgical site infection (n = 32; 21%); 55 (37%) patients had long-term complications (> 30 days) postoperatively, the most common of which was a return to the operating room (n = 19; 13%) largely for perineal wounds. Thirty-day mortality was zero. 4.8%, 47.6%, 65.3% and 84.4% of patients had undergone pouch excision by 1, 5, 10 and 20 years from the time of pouch construction, respectively.
    Conclusions: Pouch excision has a high rate of both short- and long-term postoperative complications. Patients should be appropriately counselled to set expectations accordingly. In view of these findings we suggest that this operation should ideally be performed at a high volume centre with the availability of a multidisciplinary surgical team.
    Language English
    Publishing date 2017-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.13673
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  10. Article ; Online: Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience.

    Baek, S-J / Dozois, E J / Mathis, K L / Lightner, A L / Boostrom, S Y / Cima, R R / Pemberton, J H / Larson, D W

    Techniques in coloproctology

    2016  Volume 20, Issue 6, Page(s) 369–374

    Abstract: Purpose: A laparoscopic approach to proctocolectomy and ileal pouch-anal anastomosis (IPAA) in patients with chronic ulcerative colitis and familial adenomatous polyposis has grown in popularity secondary to reports of small series demonstrating short- ... ...

    Abstract Purpose: A laparoscopic approach to proctocolectomy and ileal pouch-anal anastomosis (IPAA) in patients with chronic ulcerative colitis and familial adenomatous polyposis has grown in popularity secondary to reports of small series demonstrating short-term patient benefits. Limited data exist in large numbers of patients undergoing laparoscopic ileal pouch-anal anastomosis (L-IPAA). We aimed to analyze surgical outcomes in a large cohort of patients undergoing L-IPAA.
    Methods: From a prospectively maintained surgical database, 30-day surgical outcome data were reviewed for all L-IPAA performed for chronic ulcerative colitis and familial adenomatous polyposis from 1999 to 2012. Demographics, operative approach, and operative and postoperative complications were analyzed.
    Results: A total of 588 L-IPAA ileal pouch-anal anastomoses were performed predominantly for chronic ulcerative colitis (93.9 %). The mean age was 36.2 years, and 54.3 % were male, with a mean BMI of 24.1 kg/m(2). Three-stage operations were performed in 17.7 %. The mean operating time of the patients excluding 3-stage operation was 269.4 min. Minimally invasive techniques included hand-assist in 55 % and straight laparoscopy in 45 %. Conversion to open occurred in 8.8 %. Median length of stay was 5 days. There was no mortality. Complications occurred in 36.9 % of patients: Clavien grade I (17.5 %), grade II (72.8 %), and grade III (9.7 %). Analysis of the grouped data over time demonstrated a statistically significant reduction in operative time (p < 0.001) and an increase in the ratio of hand-assisted over straight laparoscopy (p = 0.001).
    Conclusions: Minimally invasive IPAA performed using either a laparoscopic or hand-assisted technique is safe, can be performed with low conversion rates, and confers beneficial perioperative outcomes.
    MeSH term(s) Adenomatous Polyposis Coli/surgery ; Adolescent ; Adult ; Aged ; Anal Canal/surgery ; Anastomosis, Surgical/methods ; Colitis, Ulcerative/surgery ; Colonic Pouches ; Conversion to Open Surgery/statistics & numerical data ; Databases, Factual ; Feasibility Studies ; Female ; Humans ; Ileum/surgery ; Laparoscopy/methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/etiology ; Proctocolectomy, Restorative/methods ; Prospective Studies ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2016-04-27
    Publishing country Italy
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-016-1465-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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