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Shen B. Endoscopic Evaluation of the Ileal Pouch. Dis Colon Rectum 2024; 67:S52-S69. [PMID: 38276962 DOI: 10.1097/dcr.0000000000003269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Structural and inflammatory adverse sequelae are common after restorative proctocolectomy and IPAA. On rare occasions, neoplasia can occur in patients with ileal pouches. Pouchoscopy plays a key role in the diagnosis, differential diagnosis, disease monitoring, assessment of treatment response, surveillance, and delivery of therapy. OBJECTIVE A systematic review of the literature was performed, and principles and techniques of pouchoscopy were described. DATA SOURCES PubMed, Google Scholar, and Cochrane databases. STUDY SELECTION Relevant articles on endoscopy in ileal pouches published between January 2000 and May 2023 were included based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. INTERVENTION Diagnostic, surveillance, and therapeutic endoscopy in ileal pouch disorders were included. MAIN OUTCOME MEASURES Accurate characterization of the ileal pouch in healthy or diseased states. RESULTS The main anatomic structures of a J- or S-pouch are the stoma closure site, prepouch ileum, inlet, tip of the "J," pouch body, anastomosis, cuff, and anal transition zone. Each anatomic location can be prone to the development of structural, inflammatory, or neoplastic disorders. For example, ulcers and strictures are common at the stoma closure site, inlet, and anastomosis. Leaks are commonly detected at the tip of the "J" and anastomosis. Characterization of the anastomotic distribution of inflammation is critical for the differential diagnosis of subtypes of pouchitis and other inflammatory disorders of the pouch. Neoplastic lesions, albeit rare, mainly occur at the cuff, anal transition zone, or anastomosis. LIMITATIONS This is a qualitative, not quantitative, review of mainly case series. CONCLUSIONS Most structural, inflammatory, and neoplastic disorders can be reliably diagnosed with a careful pouchoscopy. The endoscopist and other clinicians taking care of pouch patients should be familiar with the anatomy of the ileal pouch and be able to recognize common abnormalities. See video from symposium.
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Affiliation(s)
- Bo Shen
- The Global Integrated Center for Colorectal Surgery and Interventional Endoscopy and Center for Inflammatory Bowel Diseases, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York
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Hanna QEB, Tripp DA, Geirc M, Gnat L, Moayyedi P, Beyak M. Psychosocial factors associated with j-pouch surgery for patients with IBD: a scoping review. Qual Life Res 2023; 32:3309-3326. [PMID: 37347396 DOI: 10.1007/s11136-023-03454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Ulcerative colitis and Crohn's disease are subtypes of inflammatory bowel disease: a chronic condition of unclear etiology characterized by inflammation of the small and large intestine. Inflammatory bowel disease is managed with diet, medications, and surgeries, with the most common surgery, recommended to ulcerative colitis patients being j-pouch surgery. PURPOSE To assess the current literature concerning psychosocial factors associated with j-pouch surgery for patients with inflammatory bowel disease. METHODS A systematic scoping review of the empirical and grey literature was conducted for original research on j-pouch surgery and psychosocial variables. Eight databases were searched: Medline, PsychInfo, CINAHL, EBM Reviews, ProQuest Dissertations and Theses Global, ResearchGate, Prospero, and PrePubMed. RESULTS Thirty-nine articles were identified. Many studies (n = 18) adopted a case-series design, and none examined psychosocial interventions. The most popular psychosocial variables assessed were quality of life (n = 34) and those associated with sexual health and functioning (n = 9). CONCLUSIONS Despite being an established surgical procedure, little research has examined the psychosocial implications of j-pouch surgery. As such, clinicians lack a robust understanding of how this procedure affects patients' psychiatric and social status and adaptive abilities. There is a need for high-quality research utilizing validated measures and rigorous design methodologies with control populations.
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Affiliation(s)
- Quincy E B Hanna
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Department's of Psychology, Anesthesiology & Urology, Queen's University, Kingston, ON, Canada.
| | - Madelaine Geirc
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Lauren Gnat
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Paul Moayyedi
- Department Gastroenterology, McMaster University, Hamilton, ON, Canada
| | - Michael Beyak
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Oltean I, Travis N, Kaur M, Grandpierre V, Hayawi L, Tsampalieros A, Nasr A. Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000354. [DOI: 10.1136/wjps-2021-000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022] Open
Abstract
BackgroundThe efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate. A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis (IPAA) with ileostomy (diverted) versus the undiverted procedure.MethodsRecords were sourced from CINAHL, CENTRAL, EMBASE and MEDLINE databases. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without ileostomy. The primary outcome was the occurrence of postoperative leaks, and the secondary outcomes were presence of postoperative small bowel obstruction (SBO), pouchitis, stricture and fistula complications. A random-effects meta-analysis was used.ResultsTwenty-three observational studies in the systematic review were included with 658 patients (83% diverted, 17% undiverted). Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.17 to 1.64, I2=16%). There was no difference in the occurrence of SBO, pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without (SBO: OR 2.27, 95% CI 0.52 to 9.92, I2=0%, pouchitis: OR 1.76, 95% CI 0.95 to 3.24, I2=0%, strictures: OR 2.72, 95% CI 0.44 to 16.69, I2=66%).ConclusionThe meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.
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Laparoscopic robotic-assisted restorative proctocolectomy and ileal J-pouch-anorectal anastomosis in children. Pediatr Surg Int 2022; 38:59-68. [PMID: 34586484 DOI: 10.1007/s00383-021-05017-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Total proctocolectomy with ileal J-pouch-anorectal anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC) in children. Considering the well-known advantages of minimally invasive approach, and its main application for the deep pelvis, robotic surgery may be used in UC reconstructive procedures. The aim of the study is to report our experience with Robotic IPAA in children. METHODS Single surgeon experience on Robotic IPAA were prospectively included. Data on patient demographics, surgical details, complications, and length of stay (LOS), were collected. RESULTS Fifteen patients were included. Median age was 13.2 years, median body weight 45 kg. Median operative time was 240 min. Median LOS was 7 days and mean follow-up time 1 year. No intraoperative complication occurred. Five postoperative complications happened: 3 minors treated conservatively (CD I-II), 2 majors needing reintervention under anesthesia (CD IIIb). No mortality was observed. CONCLUSION Our preliminary experience reveals that Robotic IPAA is a safe and feasible option for the surgical treatment of UC in children. A bigger patient sample and a long-term follow-up are needed to confirm our findings.
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Drews JD, Onwuka EA, Fisher JG, Huntington JT, Dutkiewicz M, Nogalska A, Nwomeh BC. Complications after proctocolectomy and ileal pouch-anal anastomosis in pediatric patients: A systematic review. J Pediatr Surg 2019; 54:1331-1339. [PMID: 30291026 DOI: 10.1016/j.jpedsurg.2018.08.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Colectomy with ileal pouch-anal anastomosis (IPAA) is the standard of care for patients with familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). The rates of postoperative complications are not well established in children. The objective of this systematic review is to establish benchmark data for morbidity after pediatric IPAA. METHODS PubMed, Embase, and The Cochrane Library were searched for studies of colectomy with IPAA in patients ≤21 years old. UC studies were limited to the anti-tumor necrosis factor-α agents era (1998-present). All postoperative complications were extracted. RESULTS Thirteen studies met the inclusion criteria (763 patients). Compared to patients with FAP, UC patients had a higher prevalence of pouch loss (10.6% vs. 1.5%). Other major complications such as anastomotic leak, abscess, and fistula were uncommon (mean prevalence 4.9%, 4.2%, and 5.0%, respectively, for patients with UC; 8.7%, 4.2%, and 4.3% for FAP). The most frequent complication was pouchitis (36.4% of UC patients). CONCLUSIONS Devastating complications from colectomy and IPAA are rare, but patients with UC have poorer outcomes than those with FAP. Much of the morbidity may therefore stem from patient or disease factors. Multicenter, prospective studies are needed to identify modifiable risks in patients with UC undergoing IPAA. LEVEL OF EVIDENCE Prognostic, level II.
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Affiliation(s)
- Joseph D Drews
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210.
| | - Ekene A Onwuka
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210.
| | - Jeremy G Fisher
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205.
| | - Justin T Huntington
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205.
| | - Michał Dutkiewicz
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205.
| | - Agata Nogalska
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205.
| | - Benedict C Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210.
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Morbidity and Risk Factors of Laparoscopic-Assisted Ileostomies in Children With Ulcerative Colitis. J Pediatr Gastroenterol Nutr 2016; 62:858-62. [PMID: 26529347 DOI: 10.1097/mpg.0000000000001025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Laparoscopic-assisted ileostomy (LAI) represents a cornerstone for the staged approach to ulcerative colitis (UC). The aim is to determine stoma morbidity in a series of pediatric patients and possibly identify specific risk factors. METHODS All of the patients who underwent LAI for UC between January 2008 and December 2014 were included. The following data were collected: patient demographics, preoperative medical treatment, body mass index (BMI) at surgery, Pediatric UC Index (PUCAI), and stoma-related complications. In this series of patients, a staged approach has been adopted (subtotal colectomy + ileostomy; restorative proctocolectomy with J-pouch ileo-rectal anastomosis + ileostomy; ileostomy closure). RESULTS Seventy-two LAIs were fashioned in 37 pediatric patients with UC. Median age at surgery was 12 years (range 5-14.8 years). Boy to girl ratio was 0.85:1. Mortality was zero. Complications occurred after 8 procedures after a median of 31 days postoperatively (range 8-60 days). Those were significantly more frequent in the case of BMI-z score >-0.51 (deleted in revised manuscript, ie, relatively overweight patients) and in the case of preoperative azathioprine administration. Pediatric UC Index score, sex, number of preoperative medications, and other preoperative parameters did not correlate with the incidence of complications. CONCLUSIONS Our study suggests to keep a prudent behavior in the case of patients with a BMI-z score >-0.51 and received preoperative azathioprine administration. Parents should be adequately acknowledged on this regard.
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Huntington JT, Boomer LA, Pepper VK, Diefenbach KA, Dotson JL, Nwomeh BC. Minimally Invasive Ileal Pouch-Anal Anastomosis with Rectal Eversion Allows for Equivalent Outcomes in Continence in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2016; 26:222-5. [DOI: 10.1089/lap.2015.0429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Justin T. Huntington
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura A. Boomer
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Victoria K. Pepper
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karen A. Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer L. Dotson
- Department of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio
| | - Benedict C. Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
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Pini-Prato A, Faticato MG, Barabino A, Arrigo S, Gandullia P, Mazzola C, Disma N, Montobbio G, Mattioli G. Minimally invasive surgery for paediatric inflammatory bowel disease: Personal experience and literature review. World J Gastroenterol 2015; 21:11312-11320. [PMID: 26525138 PMCID: PMC4616207 DOI: 10.3748/wjg.v21.i40.11312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/02/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of paediatric inflammatory bowel disease (PIBD) has dramatically increased in the last 20 years. Although first reported in mid 1970s’, diagnostic laparoscopy has started to be routinely adopted in paediatric surgical practice since late 1990s’. Minimally invasive surgery was first limited to diagnostic purposes. After 2002 it was also applied to the radical treatment of PIBD, either Crohn’s disease (CD) or Ulcerative colitis. During the last decade minimally invasive approaches to PIBD have gained popularity and have recently became the “gold standard” for the treatment of such invalidating and troublesome chronic diseases. The authors describe and track the historical evolution of minimally invasive surgery for PIBD and address all available opportunities, including most recent advancements such as robotic surgery, single port approaches and minimally invasive treatment of perianal fistulising CD. A systematic review of all series of PIBD treated with minimally invasive approaches published so far is provided in order to determine the incidence and type of patients’ complications reported up to present days. The authors also describe their experience with minimally invasive surgery for PIBD and will report the results of 104 laparoscopic procedures performed in a series of 61 patients between January 2006 and December 2014.
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Mattioli G, Barabino A, Aloi M, Arrigo S, Caldaro T, Carlucci M, Cucchiara S, De Angelis P, Di Leo G, Illiceto MT, Impellizzeri P, Leonelli L, Lisi G, Lombardi G, Martelossi S, Martinelli M, Miele E, Randazzo A, Romano C, Romeo C, Romeo E, Selvaggi F, Valenti S, Dall'Oglio L. Paediatric ulcerative colitis surgery: Italian survey. J Crohns Colitis 2015; 9:558-64. [PMID: 25895877 DOI: 10.1093/ecco-jcc/jjv065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Recent epidemiological studies showed an increase in ulcerative colitis among children, especially in its aggressive form, requiring surgical treatment. Although medical therapeutic strategies are standardized, there is still no consensus regarding indications, timing and kind of surgery. This study aimed to define the surgical management of paediatric ulcerative colitis and describe attitudes to it among paediatric surgeons. METHODS This was a retrospective cohort study. All national gastroenterology units were invited to participate. From January 2009 to December 2013, data on paediatric patients diagnosed with ulcerative colitis that required surgery were collected. RESULTS Seven units participated in the study. Seventy-one colectomies were performed (77.3% laparoscopically). Main surgical indications were a severe ulcerative colitis attack (33.8%) and no response to medical therapies (56.3%). A three-stage strategy was chosen in 71% of cases. Straight anastomosis was performed in 14% and J-pouch anastomosis in 86% of cases. A reconstructive laparoscopic approach was used in 58% of patients. Ileo-anal anastomosis was performed by the Knight-Griffen technique in 85.4% and by the pull-through technique in 9.1% of patients. Complications after colectomy, after reconstruction and after stoma closure were reported in 12.7, 19.3 and 35% of cases, respectively. CONCLUSIONS This study shows that there is general consensus regarding indications for surgery. The ideal surgical technique remains under debate. Laparoscopy is a procedure widely adopted for colectomy but its use in reconstructive surgery remains limited. Longer follow-up must be planned to define the quality of life of these patients.
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Affiliation(s)
- G Mattioli
- DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - A Barabino
- Pediatric Gastroenterology Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - M Aloi
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - S Arrigo
- Pediatric Gastroenterology Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - T Caldaro
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Carlucci
- DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - S Cucchiara
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - P De Angelis
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Di Leo
- Gastroenterology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - M T Illiceto
- Department of Pediatrics, Unit of Pediatric Gastroenterology and Digestive Endoscopy - Ospedale Civile Spirito Santo, Pescara, Italy
| | - P Impellizzeri
- Pediatric Surgery Unit, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - L Leonelli
- DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - G Lisi
- Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti, Chieti Italy
| | - G Lombardi
- Department of Pediatrics, Unit of Pediatric Gastroenterology and Digestive Endoscopy - Ospedale Civile Spirito Santo, Pescara, Italy
| | - S Martelossi
- Gastroenterology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - M Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - E Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - A Randazzo
- IBD Unit Pediatric Department,University of Messina, Messina, Italy
| | - C Romano
- IBD Unit Pediatric Department,University of Messina, Messina, Italy
| | - C Romeo
- Pediatric Surgery Unit, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - E Romeo
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Selvaggi
- Unit of General Surgery, University of Naples 'Fedrico II', Naples, Italy
| | - S Valenti
- IBD Unit Pediatric Department,University of Messina, Messina, Italy
| | - L Dall'Oglio
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Perger L, Little DC, Muensterer OJ, Chong AJ, Mortellaro VE, Harmon CM. Minimal access laparoscopic surgery for treatment of ulcerative colitis and familial adenomatous polyposis coli in children and adolescents. J Laparoendosc Adv Surg Tech A 2014; 24:731-4. [PMID: 25247476 DOI: 10.1089/lap.2014.0390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Laparoscopic restorative proctocolectomy is standard surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis coli (FAP). Scar burden can be minimized by reducing the number of laparoscopic ports. The aim of this study is to review the authors' experience with reduced-port laparoscopy in this setting and to compare it with conventional laparoscopy using multiple ports. MATERIALS AND METHODS Charts of pediatric patients undergoing colectomy for UC or FAP between 2009 and 2012 were retrospectively reviewed. Patients who had the operation performed through one or two multichannel ports were assigned to the minimal access (MA) study group. Patients who had four or five single-channel ports with or without an additional small laparotomy were assigned to the LAP group. RESULTS Twenty-two patients were identified. Ages at first operation were 2-18 years (median, 13.5 years). There were no conversions to laparotomy and no mortality. Mean operative times for the MA and LAP groups, respectively, were 250 and 284 minutes for abdominal colectomy with end ileostomy (P=.15), 198 and 301 minutes for completion proctectomy with diverting loop ileostomy (DLI) (P=.26), and 455 and 414 minutes for proctocolectomy with ileal pouch-anal anastomosis and DLI (P=.72). A major complication requiring laparotomy occurred in 1 patient (9%) in the MA group and in 2 patients (18%) in the LAP group. CONCLUSIONS Minimal access laparoscopic surgery for UC and FAP is safe and feasible. A slightly larger incision at the ostomy site facilitates extraction of the specimen and extracorporeal construction of a J-pouch. Operative times and hospital stay are comparable to those with multiport laparoscopy.
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Affiliation(s)
- Lena Perger
- 1 McLane's Children's Hospital at Scott & White, Texas A&M College of Medicine , Temple, Texas
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Wahbeh GT, Suskind DL, Lee SD, Waldhausen JT, Murray KF. The pediatric pouch in inflammatory bowel disease: a primer for the gastroenterologist. Expert Rev Gastroenterol Hepatol 2013; 7:215-23. [PMID: 23445231 DOI: 10.1586/egh.12.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pediatric severe ulcerative colitis that is resistant to current medical treatment can successfully be managed surgically with a colectomy, ileal pouch creation and pouch-anal anastomosis. Key issues that should be considered and discussed before the pouch option can be offered include alternative surgical procedures, pouch function expectations, risk of surgical leak, pelvic sepsis, anastomotic strictures, acute and chronic pouch inflammation, Crohn's disease of the pouch and risk of reduced fertility for females. A long-term risk is malignancy of the residual colonic tissue. The decision to proceed with a pouch or not poses a substantial emotional burden to the child and family. Despite the risk of surgical complications and pouch inflammatory and functional challenges, the overwhelming majority of children and their families are satisfied with their pouch surgery outcomes. Further study is needed to assess preoperative risk predictors, prevention and treatment of complications.
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Affiliation(s)
- Ghassan T Wahbeh
- Inflammatory Bowel Disease Program, Seattle Children's Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Linden BC, Bairdain S, Shamberger RC, Zurakowski D, Lillehei CW. Technique of laparoscopic-assisted total proctocolectomy and ileal pouch anal anastomosis in children and adolescents: a single center's 8-year experience. J Pediatr Surg 2012; 47:2345-8. [PMID: 23217903 DOI: 10.1016/j.jpedsurg.2012.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 07/03/2012] [Accepted: 08/13/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic techniques have been applied to restorative proctocolectomy since the early 2000s. We have employed a technique for laparoscopic-assisted total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) for the treatment of children with ulcerative colitis (UC). METHODS A total of 68 children underwent laparoscopic-assisted TPCs at our institution from June 2003 to February 2011. The patients ranged from 5 to 22 years of age. We progressively modified our surgical approach in positioning, equipment use, and operative technique. RESULTS A total of 68 children underwent laparoscopic-assisted TPC within the 8-year time period. Two major complications occurred (2/68=3%) consisting of 1 duodenal injury and 1 small bowel injury. There were 6 minor complications (6/68=9%), including 5 stoma revisions and 1 port site hernia. There were no superficial wound infections. There were no reported cases of pouch fistulas, anastomotic breakdown, or neurovascular injuries. CONCLUSIONS Our surgical technique is safe and effective in treating children with UC.
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Affiliation(s)
- Bradley C Linden
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Single-port laparoscopic surgery for inflammatory bowel disease. Minim Invasive Surg 2012; 2012:106878. [PMID: 22619710 PMCID: PMC3350982 DOI: 10.1155/2012/106878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 12/26/2022] Open
Abstract
Background. Single Port Laparoscopic Surgery (SPLS) is being increasingly employed in colorectal surgery for benign and malignant diseases. The particular role for SPLS in inflammatory bowel disease (IBD) has not been determined yet. In this review article we summarize technical aspects and short term results of SPLS resections in patients with Crohn's disease or ulcerative colitis. Methods. A systematic review of the literature until January 2012 was performed. Publications were assessed for operative techniques, equipment, surgical results, hospital stay, and readmissions. Results. 34 articles, published between 2010 and 2012, were identified reporting on 301 patients with IBD that underwent surgical treatment in SPLS technique. Surgical procedures included ileocolic resections, sigmoid resections, colectomies with end ileostomy or ileorectal anastomosis, and restorative proctocolectomies with ileum-pouch reconstruction. There was a wide variety in the surgical technique and the employed equipment. The overall complication profile was similar to reports on standard laparoscopic surgery in IBD. Conclusions. In experienced hands, single port laparoscopic surgery appears to be feasible and safe for the surgical treatment of selected patients with IBD. However, evidence from prospective randomized trials is required in order to clarify whether there is a further benefit apart from the avoidance of additional trocar incisions.
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