Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience

Abstract

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.

Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis

“…In comparison to most reported series in UC surgery, we had a very high laparoscopic rate (86% of SCo from 2008) [ 11 , 39 , 47 , 48 ]; while usually more than half of SCo are still performed by an open approach, as recently confirmed by large databases [ 49 , 50 ]. On the contrary, the conversion rate was quite low (1.1%), especially considering that reported conversion rate in trials and observational studies ranges from 1 to 23% [ 8 , 24 , 39 , 45 , 51 , 52 , 53 , 54 ], and that conversion rate after laparoscopic cholecystectomy, the most popular laparoscopic procedure, is reported to be 5–10% [ 55 ].…”

“…The laparoscopic approach has been proposed based on several short- and long-term advantages, such as less perioperative complications, short recovery and hospital discharge, fewer adhesions and incisional hernias, enhanced body image, and preservation of fecundity in female patients. Toxic megacolon, massive hemorrhage, and hemodynamic instability are still considered the main contraindications to laparoscopy [ 1 , 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. If the elevated cost of laparoscopic devices should be compensated by shorter postoperative hospitalization, a longer operating time could be considered a drawback of laparoscopy, compared to open surgery, especially in referral hospitals with a busy urgent list.…”

Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results

“…In this series, the patients were consecutive and unselected, and the only reason for an open procedure, apart from clinical contraindications, was previous major open abdominal surgery. Applying these criteria, contraindication to laparoscopy was 16.1%, but conversion rate was very low (3.75%), considering that reported conversion rate in trials and observational studies ranges from 1 to 23% [49][50][51][52][53][54][55][56] , and that conversion rate after laparoscopic cholecystectomy, the most popular laparoscopic procedure, is reported to be 5-10% 57 . Emergency sub-total colectomy for acute colitis in IBD is a potentially lifethreatening procedure, with a reported mortality rate that ranges, in Europe and North America, from 1% to 13% [4][5][6]46 .…”

The current state of the transanal approach to the ileal pouch-anal anastomosis

“…Technical advances, such as using minimally invasive surgery (MIS) for the IPAA procedure, could help minimize these risks. MIS has proven benefits, but the application of a MIS approach in Inflammatory Bowel Disease (IBD) has been limited with the existing platforms [3,4,[5][6][7]. While laparoscopic IPAA is safe, feasible, and has clinical benefits over open surgery, there are technical limitations with the laparoscopic approach, such as the anatomic constraints of the fixed, bony pelvis, and the challenges of visualization and instrumentation in the deep pelvic dissection [11].…”

“…The first two patients had a hand-sewn anastomosis, and the subsequent 14 had a stapled anastomosis. The median operative time was 247 (range, 185-470) minutes, and the median hospital stay was 6 (range,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] days. Only one case of anastomotic leakage was reported at two weeks postoperatively.…”