Single access laparoscopic total colectomy for severe refractory ulcerative colitis

Abstract

Background: Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision. While intuitively appealing, there is sparse evidence for its use beyond feasibility.

Aim: To examine the usefulness of single access laparoscopy (SAL) in a general series experience of patients sick with ulcerative colitis.

Methods: All patients presenting electively, urgently or emergently over a three-year period under a colorectal specialist team were studied. SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a "surgical glove port" allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery. Standard, straight rigid laparoscopic instrumentation were used without additional resource.

Results: Of 46 consecutive patients requiring surgery, 39 (85%) had their procedure begun laparoscopically. 27 (69%) of these were commenced by single port access with an 89% completion rate thereafter (three were concluded by multi-trocar laparoscopy). SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs (> 100€case) and postoperative hospital stay (median 5 d vs 7.5 d, P = 0.045) without increasing operative time. It proved especially efficient in those with preoperative albumin > 30 g/dL (n = 20). Its comparative advantages were further confirmed in ten pairs case-matched for gender, body mass index and preoperative albumin. SAL outcomes proved durable in the intermediate term (median follow-up = 20 mo).

Conclusion: Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis. Assumptions regarding duration and cost should not be barriers to its implementation.

Keywords: Case match analysis; Inflammatory bowel disease; Minimal access surgery; Single incision laparoscopy; Total colectomy and end ileostomy; Ulcerative colitis.

Figure 1

Photographs detailing the surgical glove port set-up for single port total colectomy with end ileostomy.

Figure 2

The end ileostomy was then matured at the single port access site. Intraoperative photographs showing (A) operating via the stoma site port during the procedure (B) the colonic specimen after extraction via the stoma site incision (C) The end ileostomy fashioned at the site of the single port as the only operative incision.

Figure 3

Daily median C-reactive protein level following surgery by access (multiport versus single port) including by the patients preoperative albumin (< or > 30 g/dL).