Impact of single‐incision laparoscopic surgery on postoperative analgesia requirements after total colectomy for ulcerative colitis: a propensity‐matched comparison with multiport laparoscopy

Abstract

Aim To compare the requirements for postoperative analgesia in patients with ulcerative colitis after single‐incision versus multiport laparoscopic total colectomy. Method All patients undergoing single‐incision or multiport laparoscopic total colectomy as a first stage in the surgical treatment of ulcerative colitis between 2010 and 2016 at the University Hospital of Leuven were included. The cumulative dose of postoperative patient‐controlled analgesia was used as the primary end‐point. A Z‐transformation was performed combining values for patient‐controlled epidural analgesia and patient‐controlled intravenous analgesia, resulting in one hybrid outcome variable. The two groups were matched using propensity scores. Subgroup analysis was performed to analyse the impact of extraction site on postoperative pain. Results A total of 81 patients underwent total colectomy for ulcerative colitis (median age 35 years). Thirty patients underwent single‐incision laparoscopy, while 51 patients had a multiport approach. The mean normalized patient‐controlled analgesia dose was significantly lower in patients undergoing single‐incision laparoscopy (−0.33 vs 0.46, P < 0.001). This difference was no longer significant in subgroup analysis for patients with stoma site specimen extraction (P = 0.131). The odds of receiving tramadol postoperatively was 3.66 times lower after single‐incision laparoscopy (P = 0.008). The overall morbidity rate was 32.1% (26/81). The mean Comprehensive Complication Index in single‐incision and multiport laparoscopy group was 18.33 and 21.39, respectively (P = 0.506). Hospital stay was significantly shorter after single‐incision laparoscopic surgery (6.3 days vs 7.6 days, P = 0.032). Conclusion Single‐incision total colectomy was associated with lower postoperative analgesia requirements and shorter hospital stay, with comparable morbidity. However, the specimen extraction site played a significant role in postoperative pain control.

Comparative review of outcomes: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

“…Furthermore, mesh fixation without tacks helped reduce postoperative pain, and this is consistent with some study reports stating that a direct relationship exists between aggressive mesh fixation and postoperative pain [ 25 , 26 ]. Meanwhile, SILS circumvents the multi-channel puncture of conventional laparoscopy, resulting in less postoperative pain [ 27 , 28 ], low risk of damage to abdominal wall vessels during trocar instrumentation, and less impact on the integrity of the abdominal wall [ 29 ]. It should be added that although intermittent transabdominal stitches was used to close the defect in 80% of the SIL-TES group as in the IPOM group, there was still a significant difference in closure method between the two groups.…”

Short-term curative effect of laparoscopic assisted surgery on patients with congenital intestinal malrotation and its effect on gastrointestinal function in very low birth weight infants.

“…The Ladd procedure to relieve obstruction is the first choice for the treatment of congenital malrotation. With the widespread use of laparoscopic surgery and pediatric surgical diseases [ 10 ], the laparoscopic Ladd procedure for the treatment of intestinal malrotation has been chosen by more and more surgeons. Compared with traditional open surgery, it has the advantages of a small incision, beautiful appearance, quick postoperative recovery, and small scars.…”

Postoperative Pain After Enhanced Recovery Pathway Robotic Colon and Rectal Surgery: Does Specimen Extraction Site Matter?

“…This study did not include patients with single-site operations and transvaginal and transrectal specimen extraction sites that may confer less postoperative pain and less opioid pain medication requirements. 25 These options require further investigation.…”