Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6015
Peer-review started: December 31, 2019
First decision: February 19, 2020
Revised: June 15, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: October 21, 2020
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.
To examine the usefulness of single access laparoscopy (SAL) in a general series experience of patients sick with ulcerative colitis.
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.
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).
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.
Core Tip: Single access laparoscopy performed via the stoma site for patient’s sick with ulcerative colitis and needing total colectomy with ileostomy is shown to be appropriate and with some advantages over its multiport equivalent. Operative costs and total hospital stay were significantly reduced with the Single access laparoscopy approach (using a “glove port”) and outcomes were sustained in the intermediate term.