1
|
Violante T, Behm KT, Shawki SF, Ferrari D, D'Angelo ALD, Kelley SR, Nitin M, Larson DW. Robotic-assisted reoperative ileal pouch-anal anastomosis: robotic pouch excision and pouch revision. Tech Coloproctol 2024; 28:43. [PMID: 38561571 DOI: 10.1007/s10151-024-02918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Up to 20% of patients with ileal pouch will develop pouch failure, ultimately requiring surgical reintervention. As a result of the complexity of reoperative pouch surgery, minimally invasive approaches were rarely utilized. In this series, we present the outcomes of the patients who underwent robotic-assisted pouch revision or excision to assess its feasibility and short-term results. METHODS All the patients affected by inflammatory bowel diseases and familial adenomatous polyposis who underwent robotic reoperative surgery of an existing ileal pouch were included. RESULTS Twenty-two patients were included; 54.6% were female. The average age at reoperation was 51 ± 16 years, with a mean body mass index of 26.1 ± 5.6 kg/m2. Fourteen (63.7%) had a diagnosis of ulcerative colitis at reoperation, and seven (31.8%) had Crohn's disease. The mean time to pouch reoperation was 12.8 ± 11.8 years. Seventeen (77.3%) patients underwent pouch excision, and five (22.7%) had pouch revision surgery. The mean operative time was 372 ± 131 min, and the estimated blood loss was 199 ± 196.7 ml. The conversion rate was 9.1%, the 30-day morbidity rate was 27.3% (with only one complication reaching Clavien-Dindo grade IIIB), and the mean length of stay was 5.8 ± 3.9 days. The readmission rate was 18.2%, the reoperation rate was 4.6%, and mortality was nihil. All patients in the pouch revisional group are stoma-free. CONCLUSION Robotic reoperative pouch surgery in highly selected patients is technically feasible with acceptable outcomes.
Collapse
Affiliation(s)
- Tommaso Violante
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, ARZ, USA
- School of General Surgery, Alma Mater Studiorum, Università Di Bologna, Bologna, Italy
| | - Kevin T Behm
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Sherief F Shawki
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Davide Ferrari
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, ARZ, USA
- School of General Surgery, Alma Mater Studiorum, Università Di Bologna, Bologna, Italy
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Anne-Lise D D'Angelo
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Scott R Kelley
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Mishra Nitin
- Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, ARZ, USA
| | - David W Larson
- Department of Colon and Rectal Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA.
| |
Collapse
|
2
|
"Relaparoscopy" to treat early complications following colorectal surgery. Surg Endosc 2021; 36:3136-3140. [PMID: 34159459 DOI: 10.1007/s00464-021-08616-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic surgery has shown clear benefits that could also be useful in the emergency setting such as early reoperations after colorectal surgery. The aim of this study was to evaluate the safety and feasibility of laparoscopic reintervention ("relaparoscopy") (RL) to manage postoperative complications after laparoscopic colorectal surgery. METHODS We performed a retrospective study based on a prospectively collected database from 2000 to 2019. Patients who required a reoperation after undergoing laparoscopic colorectal surgery were included. According to the approach used at the reoperation, the cohort was divided in laparoscopy (RL) and laparotomy (LPM). Demographics, hospital stay, morbidity, and mortality were analyzed. RESULTS A total of 159 patients underwent a reoperation after a laparoscopic colorectal surgery: 124 (78%) had RL and 35 (22%) LPM. Demographics were similar in both groups. Patients who underwent left colectomy were more frequently reoperated by laparoscopy (RL: 42.7% vs. LPM: 22.8%, p: 0.03). The most common finding at the reoperation was anastomotic leakage, which was treated more often by RL (RL: 67.7% vs. LPM: 25.7%, p: 0.0001), and the most common strategy was drainage and loop ileostomy (RL: 65.8% vs. LPM: 17.6%, p: 0.00001). Conversion was necessary in 12 patients (9.6%). Overall morbidity rate was 52.2%. Patients in the RL group had less postoperative severe complications (RL: 12.1% vs. LPM: 22.8, p: 0.01). Mortality rate was similar in both groups. CONCLUSION Relaparoscopy is feasible and safe for treating early postoperative complications, particularly anastomotic leakage after left colectomy.
Collapse
|
3
|
Halkias C, Zoikas A, Garoufalia Z, Konstantinidis MK, Ioannidis A, Wexner S. Re-Operative Laparoscopic Colorectal Surgery: A Systematic Review. J Clin Med 2021; 10:jcm10071447. [PMID: 33916216 PMCID: PMC8036625 DOI: 10.3390/jcm10071447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Re-operative laparoscopic colorectal surgery is becoming increasingly common. It can be a challenging procedure, but its benefits can outweigh the associated risks. Methods: A systematic review of the literature reporting re-operative laparoscopic surgery was carried out. Retrospective and prospective cohort studies and case series were included, with case reports being excluded. Results: Seventeen articles dated from 2007 to 2020 were included in the systematic review. In total, 1555 patients were identified. Five hundred and seventy-four of them had a laparoscopic procedure and 981 an open re-operation. One hundred and eighty-three women had a laparoscopic operation. The median age ranged from to 44.9 years to 68.7 years. In seven studies, the indication of the index operation was malignancy, one study regarded re-laparoscopy for excision of lateral pelvic lymph nodes, and one study looked at redo surgery of ileal J pouch anal anastomosis. There were 16 mortalities in the laparoscopic arm (2.78%) and 93 (9.4%) in the open surgery arm. One hundred and thirty-seven morbidities were recorded in the open arm and 102 in the laparoscopic arm. Thirty-nine conversions to open occurred. The median length of stay ranged from 5.8 days to 19 days in laparoscopy and 9.7 to 34 days in the open surgery arm. Conclusions: Re-operative laparoscopic colorectal surgery is safe when performed by experienced hands. The management of complications, recurrence of malignancy, and lateral pelvic floor dissection can be safely performed. The complication rate is low, with conversion to open procedures being relatively uncommon.
Collapse
Affiliation(s)
- Constantine Halkias
- General Surgery Department, Brighton and Sussex University Hospitals, Brighton BN2 5BE, UK
- Correspondence:
| | - Athanasios Zoikas
- The 2nd Department of Surgery, Sismanoglio General Hospital of Attica, 15126 Athens, Greece;
| | - Zoe Garoufalia
- The 2nd Department of Propaedeutic Surgery, Laiko General Hospital, 11527 Athens, Greece;
| | - Michalis K. Konstantinidis
- Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, 15125 Athens, Greece; (M.K.K.); (A.I.)
| | - Argyrios Ioannidis
- Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, 15125 Athens, Greece; (M.K.K.); (A.I.)
| | - Steven Wexner
- Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, USA;
| |
Collapse
|