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Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease: a Single Center Experience
Antonino Spinelli*1,2, Matteo Sacchi1, Piero Bazzi1, Marco Montorsi1,2
1Dept. of Surgery, Istituto Clinico Humanitas, Rozzano Milano, Italy; 2Dept. of Medical Biotechnologies and Translational Medicine, University of Milano, Milano, Italy
Background: Single-incision laparoscopy (SIL) for colorectal surgery was first described in 2008. Since then, SIL has been reported for a variety of colorectal procedures, even though its role in inflammatory bowel disease (IBD) has not yet been determined. Aim of this study is to prospectively assess its safety and feasibility in a consecutive IBD series.
Methods: All patients presenting for IBD surgery from November 2012 until November 2013 in elective or urgent setting, were considered for a SIL approach. Data were prospectively collected. SIL was performed using a single port placed either transumbilically or at the site marked for stoma formation. Standard, straight laparoscopic instruments were used. Surgery was performed by the same team experienced in both laparoscopy and IBD surgery.
Results: out of 110 consecutive IBD patients referred for surgery over a 12 months period, 32 (18 f) underwent SIL. 29 patients were affected by Crohn's disease (CD) (recurrent in 5 cases) and 3 by Ulcerative Colitis (UC). In 28/32 (87,5%) SIL was performed using the "glove-port" (surgical glove mounted on a plastic ring retractor) while in 4/32 (12,5%) a dedicated port device was adopted. 10 patients were submitted to primary ileocecal resection, 4 to total colectomy (1 with ileo-rectal anastomosis for CD; 3 "scarless" with end-ileostomy, entirely performed through the ileostomy site, for UC); 3 patients underwent conservative surgery (9 strictureplasties) for isolated small bowel disease; 15 patients underwent SIL for complicated resections, defined as resections for recurrent CD after previous open surgery, SIL after open surgery for other indication and SIL for multifocal disease. During the same operation, in 12/32 cases mutiple procedures were performed, including jejunal (3) and sigmoid (3) resections, strictureplasties (12), perianal sepsis drainage (3). Mean operative time was 170 minutes (73-282). No patient suffered intraoperative complication. Six patients were converted to open surgery (18.7%) due to large inflammatory masses (5) or massive adesions (1). Mean postoperative stay was 6 days (range 4-21). After 7 months mean follow-up, three Class II and two Class III complications, according to Clavien-Dindo Classification were reported.
Conclusions: SIL is safe and feasible in IBD patients and can be adopted even in selected multifocal or recurrent CD patients. The use of the glove port and of standard surgical laparoscopic instrumentation does not increase costs and may facilitate the spread of this technique. Prospective comparative trials and longer follow-up are needed to prove advantages over traditional multiport laparoscopic surgery.
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