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Herman K, Nemeth S, Shen B, Church JM, Kiran RP. Laparoscopic ileal pouch-anal anastomosis reduces the risk of surgical site infections: An ACS-NSQIP study. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis. J Clin Med 2020; 9:jcm9103382. [PMID: 33096913 PMCID: PMC7589891 DOI: 10.3390/jcm9103382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still a topic of improvement. We designed a standardized 10-steps, sequential approach to laparoscopic colectomy, based on the philosophy of the “critical view of safety”, with the aim to improve perioperative outcomes (operative duration, estimated blood loss, complications, readmissions, reoperations, and length of postoperative stay). We performed a retrospective cohort study using data from a prospectively maintained clinical database. We included all the consecutive, unselected patients undergoing laparoscopic subtotal colectomy (SCo) for IBD between 2008 and 2019 in a tertiary IBD Italian Centre. Starting from 2015, we regularly adopted the novel Sequential Approach for a Critical-View Colectomy (SACCo) technique. We included 59 (40.6%) patients treated with different laparoscopic approaches, and 86 patients (59.4%) operated on by the SACCo procedure. The mean operating time was significantly shorter for the SACCo group (144 vs. 224 min; p < 0.0001). The SACCo technique presented a trend to fewer major complications (6.8% vs. 8.3%), less readmissions (2.3% vs. 13.5%; p = 0.01), and shorter postoperative hospital stay (7.2 vs. 8.8 days; p = 0.003). Laparoscopic SACCo-technique is a safe and reproducible surgical approach for acute severe colitis and may improve the outcomes of this demanding procedure.
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Mege D, Stellingwerf ME, Germain A, Colombo F, Pellino G, Di Candido F, Maggiori L, Foschi D, Buskens CJ, Adegbola S, Spinelli A, Warusavitarne J, Bemelman WA, Sampietro G, D'Hoore A, Panis Y. Management of Rectal Stump During Laparoscopic Subtotal Colectomy for Inflammatory Bowel Disease: A Comparative Cohort Study from Six Referral Centres. J Crohns Colitis 2020; 14:1214-1221. [PMID: 32191295 DOI: 10.1093/ecco-jcc/jjaa046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There is no consensus on the best management of the rectum after subtotal colectomy for refractory colitis complicating inflammatory bowel disease [IBD]. The objective was to evaluate the impact of rectal stump management during laparoscopic subtotal colectomy [LSTC] for IBD. METHODS Patients who underwent LSTC with double-end ileo-sigmoidostomy [Gr.A] or end ileostomy with closed rectal stump [Gr.B] for IBD were included from a retrospective database of six European referral centres. RESULTS In total, 314 patients underwent LSTC and were allocated to Gr.A [n = 102] and B [n = 212]. After LSTC, stoma-related complications occurred more frequently in Gr.A [12%] than in Gr.B [4%, p = 0.01]. Completion proctectomy with ileal pouch-anal anastomosis [IPAA] was performed as a three-stage procedure in all patients from Gr.A, and in 88 patients from Gr.B [42%; Gr.B1]. The other 124 patients from Gr.B underwent a modified two-stage procedure [58%; Gr.B2]. The second stage was performed laparoscopically in all patients from Gr.A compared with 73% of Gr.B1 [p < 0.0001] and 65% of Gr.B2 patients [p < 0.0001]. When laparoscopy was intended for 2nd stage IPAA, conversion to laparotomy occurred less frequently in Gr.A when compared with B1 [0 vs 5%, p = 0.06] or B2 [10%, p = 0.001]. When all surgical stages were included [LSCT and IPAA], cumulative stoma-related complications occurred more frequently in Gr.A [n = 19] than in Gr.B1 [n = 6, p = 0.02] and Gr.B2 [n = 6, p = 0.001]. CONCLUSION This study suggests that both techniques of double-end ileosigmoidostomy and end ileostomy with closed rectal stump are safe and effective for rectal stump management after laparoscopic subtotal colectomy.
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Affiliation(s)
- Diane Mege
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | | | - Adeline Germain
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Francesco Colombo
- Department of Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, St. Mark's Hospital, Harrow, UK
| | | | - Léon Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - Diego Foschi
- Department of Surgery, Luigi Sacco University Hospital, Milan, Italy
| | | | - Samuel Adegbola
- Department of Colorectal Surgery, St. Mark's Hospital, Harrow, UK
| | - Antonino Spinelli
- Department of Colorectal Surgery, Humanitas Research Hospital, Milan, Italy
| | | | - Willem A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
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Sampietro GM, Colombo F, Frontali A, Baldi CM, Carmagnola S, Cassinotti A, Dell'Era A, Massari A, Molteni P, Dilillo D, Fociani P, Tonolini M, Maconi G, Fiorina P, Corsi F, Bianco R, Nebuloni M, Zuccotti G, Ardizzone S, Foschi D. Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results. Dig Liver Dis 2018; 50:1283-1291. [PMID: 29914803 DOI: 10.1016/j.dld.2018.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/10/2018] [Accepted: 05/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages. AIMS To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients. METHODS All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation. RESULTS From July 2007 to July 2016, 160 patients entered the study. 50.6% underwent a 3-stage procedure and 49.4% a 2-stage procedure. Mortality and morbidity were 0.6% and 24.6%. Conversion rate was 3.75%. 8.7% septic complications were associated with steroids and Infliximab treatment (p = 0.0001). 3-stage patients were younger (p = 0.0001), with shorter disease duration (p = 0.0001), minor ASA scores of 2 and 3 (p = 0.0007), lower inflammatory index and better nutritional status (p = 0.003 and 0.0001), fewer Clavien-Dindo's grade II complications (p = .0001), reduced rates of readmission and reoperation at 90 days (p = 0.03), and shorter hospitalization (p = .0001), but with similar pouch and IPAA leakage, compared to 2-stage patients. 8 years pouch failure and definitive ileostomy were 5.1% and 3.7%. CONCLUSION A totally laparoscopic approach is safe and feasible, with very low mortality and morbidity rates and very low conversion rate, even in multi-stage procedures and high-risk patients.
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Affiliation(s)
- Gianluca M Sampietro
- IBD Surgical Unit, ASST Fatebenefratelli - Sacco, Milan, Italy; Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy.
| | - Francesco Colombo
- Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Alice Frontali
- Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy; Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Assistance Publique - Hôpiteau de Paris (AP-HP), Beaujon Hospital, University Denis Diderot, Paris, France
| | - Caterina M Baldi
- Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy
| | | | - Andrea Cassinotti
- Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | | | - Alessandro Massari
- Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Paola Molteni
- Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Dario Dilillo
- Division of Pediatrics, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Paolo Fociani
- Division of Pathology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Massimo Tonolini
- Division of Radiology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Giovanni Maconi
- Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Paolo Fiorina
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, Italy; Division of Endocrinology, ASST Sacco Fatebenefratelli-Sacco, Milan, Italy
| | - Fabio Corsi
- Surgery Department, Breast Unit, ICS Maugeri, Pavia, Italy; Department of Biomedical and Clinical Science L. Sacco, University of Milan, Italy
| | - Roberto Bianco
- Division of Radiology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Manuela Nebuloni
- Division of Pathology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Gianvincenzo Zuccotti
- Division of Pediatrics, ASST Fatebenefratelli - Sacco, Milan, Italy; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, Italy
| | - Sandro Ardizzone
- Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Diego Foschi
- Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy
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Campos FG, Real Martinez CA, Monteiro de Camargo MG, Cesconetto DM, Nahas SC, Cecconello I. Laparoscopic Versus Open Restorative Proctocolectomy for Familial Adenomatous Polyposis. J Laparoendosc Adv Surg Tech A 2017; 28:47-52. [PMID: 29125801 DOI: 10.1089/lap.2017.0397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE This study compared outcomes after laparoscopic (LAP) or conventional (open) total proctocolectomy with outcomes after ileal J-pouch anal anastomosis (IPAA) at a single institution. METHODS Charts from 133 familial adenomatous polyposis patients (1997-2013) were reviewed. Demographic data (age, sex, color, American Society of Anesthesiologists [ASA] status, previous surgery, and body mass index) and surgical outcomes (length of stay, early and late morbidity, reoperation, and mortality rates) were compared among 63 patients undergoing IPAA. RESULTS Demographic features were similar among patients (25 open and 38 LAP). Conversely, colorectal cancer at diagnosis prevailed in the open group (60% versus 31.6%; P = .02). Tumor stages (P = .65) and previous surgery index (20% versus 10.5%; P = .46) were similar. Surgical length was longer for LAP (374 versus 281 minutes, P = .003). Short-term complication rates (28% versus 28.9%), hospital stay (10.9 versus 8.9 days), and total long-term reoperations (28% versus 21%) were not statistically different. However, major late morbidity (16% versus 2.6%; P < .001) and late reoperation rates (16% versus 5.2%; P < .05) were greater among open patients. Both groups did not differ regarding pouch failure rates (8% versus 5.2%). There was no operative mortality in the present series. CONCLUSIONS (1) LAP IPAA is a safe procedure associated with a low conversion rate, (2) short-term results showed no clear advantages for both approaches, and (3) a greater risk of major late complications and late reoperations should be expected after open procedures.
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Affiliation(s)
- Fábio Guilherme Campos
- 1 Colorectal Surgery Division, Gastroenterology Department, Hospital das Clínicas, University of São Paulo , São Paulo, Brazil
| | | | | | - Daniele Menezes Cesconetto
- 1 Colorectal Surgery Division, Gastroenterology Department, Hospital das Clínicas, University of São Paulo , São Paulo, Brazil
| | - Sérgio Carlos Nahas
- 1 Colorectal Surgery Division, Gastroenterology Department, Hospital das Clínicas, University of São Paulo , São Paulo, Brazil
| | - Ivan Cecconello
- 1 Colorectal Surgery Division, Gastroenterology Department, Hospital das Clínicas, University of São Paulo , São Paulo, Brazil
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Coton C, Maggiori L, Mège D, Naudot C, Prost À la Denise J, Panis Y. Ileal Pouch-Anal Anastomosis for Dysplasia or Cancer Complicating Inflammatory Bowel Disease: Is Total Mesorectal Excision Always Mandatory? An Analysis of 36 Consecutive Patients. J Crohns Colitis 2017; 11:936-941. [PMID: 28369422 DOI: 10.1093/ecco-jcc/jjx044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/17/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The extent of lymph node harvesting during surgery for colorectal neoplasm [dysplasia and/or cancer] complicating inflammatory bowel disease [IBD] is a matter of debate. This study aimed to assess the risk of invasive rectal cancer in patients undergoing ileal pouch-anal anastomosis [IPAA] for colonic neoplasm complicating IBD, and thus to clarify whether a systematic total mesorectal excision [TME] should be systematically performed, or not, in those patients. METHODS From 1998 to 2015, all patients who underwent IPAA for colorectal neoplasm complicating IBD were included. Patients with preoperatively known rectal cancer were excluded. Pathological results were compared with preoperative endoscopic results. RESULTS A totalof 36 patients [mean age 49 ± 14 years], comprising 10 women [31%] and 26 men [69%], underwent IPAA for colorectal neoplasm complicating IBD, with [n = 8; 22%] or without [n = 28; 78%] TME. Rectal cancer rate in pathological specimens was 0% [0/20] in patients with preoperatively known neoplasm only limited to the colon, 0% [0/8] among patients with preoperative rectal low-grade dysplasia, and 62% [5/8] among patients with preoperatively rectal high-grade dysplasia. CONCLUSIONS These results do not support systematic TME during IPAA for colonic neoplasm complicating IBD. Considering its association with postoperative sexual disorder, TME should be discussed only on a case-by-case basis.
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Affiliation(s)
- Chloé Coton
- Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France
| | - Léon Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France
| | - Diane Mège
- Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France
| | - Clotilde Naudot
- Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France
| | | | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France
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7
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Mège D, Figueiredo MN, Manceau G, Maggiori L, Bouhnik Y, Panis Y. Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients. J Crohns Colitis 2016; 10:898-904. [PMID: 26874347 DOI: 10.1093/ecco-jcc/jjw040] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are very few studies and no consensus concerning the choice between two- and three-stage ileal pouch-anal anastomosis [IPAA] in inflammatory bowel diseases [IBD]. This study aimed to compare operative results between both surgical procedures. METHODS Only patients who underwent a laparoscopic IPAA for IBD were included. They were divided into two groups: two-stage [IPAA and stoma closure] [Group A] and three-stage IPAA [subtotal colectomy, IPAA, stoma closure] [Group B]. RESULTS From 2000 to 2015, 185 patients (107 men, median age of 42 [range, 15-78] years) were divided into Groups A [n = 82] and B [n = 103]. Patients in Group B were younger than in Group A (39 [15-78] vs 43 [16-74] years; p = 0.019), presented more frequently with Crohn's disease [16% vs 5%; p < 0.04], and were more frequently operated in emergency for acute colitis [37% vs 1%; p < 0.0001]. Cumulative operative time and length of stay were significantly longer in Group B (580 [300-900] min, and 19 [13-60] days) than in Group A (290 [145-490] min and 10 [7-47] days; p < 0.0001). Cumulative postoperative morbidity, delay for stoma closure, and function were similar between the two groups. Long-term morbidity was similar between Group A [13%] and Group B [21%; p = 0.18]. CONCLUSIONS Our study suggested that postoperative morbidity was similar between two- and three-stage laparoscopic IPAA. It suggested that the three-stage procedure is probably safer for high-risk patients [ie in acute colitis].
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Affiliation(s)
- D Mège
- Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France
| | - M N Figueiredo
- Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France Postgraduate Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - G Manceau
- Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France
| | - Y Bouhnik
- Department of Gastroenterology, Beaujon Hospital, Université Paris VII, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France
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Neumann PA, Rijcken E. Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives. World J Gastrointest Pharmacol Ther 2016; 7:217-226. [PMID: 27158537 PMCID: PMC4848244 DOI: 10.4292/wjgpt.v7.i2.217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) comprise a population of patients that have a high likelihood of both surgical treatment at a young age and repetitive operative interventions. Therefore surgical procedures need to aim at minimizing operative trauma with best postoperative recovery. Minimally invasive techniques have been one of the major advancements in surgery in the last decades and are nowadays almost routinely performed in colorectal resections irrespective of underlying disease. However due to special disease related characteristics such as bowel stenosis, interenteric fistula, abscesses, malnutrition, repetitive surgeries, or immunosuppressive medications, patients with IBD represent a special cohort with specific needs for surgery. This review summarizes current evidence of minimally invasive surgery for patients with Crohn’s disease or ulcerative colitis and gives an outlook on the future perspective of technical advances in this highly moving field with its latest developments in single port surgery, robotics and trans-anal techniques.
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Fornaro R, Caratto M, Barbruni G, Fornaro F, Salerno A, Giovinazzo D, Sticchi C, Caratto E. Surgical and medical treatment in patients with acute severe ulcerative colitis. J Dig Dis 2015; 16:558-67. [PMID: 26315728 DOI: 10.1111/1751-2980.12278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/05/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease of the mucosa of the colorectum. The treatment of UC depends on the severity of symptoms and the extent of the disease. Acute severe colitis (ASC) occurs in 12-25% of patients with UC. Patients with ASC must be managed by a multidisciplinary team. Medically or surgically aggressive treatment is carried out with the final aim of reducing mortality. Intravenous administration of corticosteroids is the mainstay of the therapy. Medical rescue therapy based on cyclosporine or infliximab should be considered if there is no response to corticosteroids for 3 days. If there has been no response to medical rescue therapy after 4-7 days, the patient must undergo colectomy in emergency surgery. Prolonged observation is counterproductive, as over time it increases the risk of toxic megacolon and perforation, with a very high mortality rate. The best potential treatment is subtotal colectomy with ileostomy and preservation of the rectum. Emergency surgery in UC should not be seen as a last chance, but can be considered as a life-saving procedure. Colectomies in emergency setting are characterized by high morbidity rates but the mortality is low.
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Affiliation(s)
- Rosario Fornaro
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
| | - Michela Caratto
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
| | - Ginevra Barbruni
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
| | - Francesco Fornaro
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
| | - Alexander Salerno
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
| | - Davide Giovinazzo
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
| | | | - Elisa Caratto
- University of Genoa, Department of Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Italy
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Kuroyanagi H, Inomata M, Saida Y, Hasegawa S, Funayama Y, Yamamoto S, Sakai Y, Watanabe M. Gastroenterological Surgery: Large intestine. Asian J Endosc Surg 2015; 8:246-62. [PMID: 26303730 DOI: 10.1111/ases.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 01/16/2023]
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11
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Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, d'Haens G, d'Hoore A, Mantzanaris G, Novacek G, Öresland T, Reinisch W, Sans M, Stange E, Vermeire S, Travis S, van Assche G. [Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management (Spanish version)]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 80:32-73. [PMID: 25769217 DOI: 10.1016/j.rgmx.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 02/06/2023]
Affiliation(s)
- A Dignass
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso.
| | | | - A Sturm
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - A Windsor
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - J-F Colombel
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - M Allez
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - G d'Haens
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - A d'Hoore
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - G Mantzanaris
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - G Novacek
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - T Öresland
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - W Reinisch
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - M Sans
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - E Stange
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - S Vermeire
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - S Travis
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
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12
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Subtotal colectomy in severe ulcerative and Crohn's colitis: what benefit does the laparoscopic approach confer? Dis Colon Rectum 2014; 57:1349-57. [PMID: 25379999 DOI: 10.1097/dcr.0000000000000238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Comparative outcome data for laparoscopic and open subtotal colectomy in IBD are lacking and often difficult to interpret owing to low case volumes, heterogeneity in case mix, and variation in laparoscopic technique. OBJECTIVE This study aimed to determine the safety of laparoscopic subtotal colectomy in severe colitis and to determine whether the laparoscopic approach improved short-term outcomes in comparison with the open approach. DESIGN This was a retrospective cohort study using data from a prospectively maintained clinical database. SETTING This study was conducted at a single center, Mount Sinai Hospital, Toronto. PATIENTS All patients undergoing subtotal colectomy for either ulcerative or Crohn's colitis between 2000 and 2011 were included. INTERVENTION A standardized operative technique was used for both laparoscopic and open subtotal colectomies. Cases performed by non-laparoscopic surgeons were excluded. MAIN OUTCOME MEASURES Perioperative outcome measures were operative duration, estimated blood loss, total morphine requirement, and length of postoperative stay. Postoperative outcome measures were the rates of minor and major complications. RESULTS Laparoscopic subtotal colectomies were performed in 131 of 290 cases (45.2%). Nine patients required conversion to an open procedure (6.9%). The uptake of laparoscopic subtotal colectomy increased from 10.2% in 2000/2001 to 71.7% in 2010/2011. Regression analysis with propensity-score adjustment for operative approach revealed that the operative duration was 25.5 minutes longer in laparoscopic cases (95% CI 12.3-38.6; p < 0.001), but that patients experienced fewer minor complications (OR 0.47; 95% CI 0.23-0.96; p = 0.04) and required less morphine (adjusted difference, -72.8 mg; 95% CI 4.9-141; p = 0.04). LIMITATIONS The inherent selection bias of this retrospective cohort study may not be accounted for by multivariate analysis with propensity-score adjustment. CONCLUSIONS Laparoscopic subtotal colectomy is safe and may reduce the rate of minor postoperative complications. The increase in operative duration reflects the technical demands associated with this procedure (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A160).
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Hata K, Kazama S, Nozawa H, Kawai K, Kiyomatsu T, Tanaka J, Tanaka T, Nishikawa T, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Watanabe T. Laparoscopic surgery for ulcerative colitis: a review of the literature. Surg Today 2014; 45:933-8. [PMID: 25346254 DOI: 10.1007/s00595-014-1053-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 09/24/2014] [Indexed: 12/15/2022]
Abstract
Despite the development of new therapies, including anti-TNF alpha antibodies and immunosuppressants, a substantial proportion of patients with ulcerative colitis (UC) still require surgery. Restorative proctocolectomy with ileal-pouch anal anastomosis is the standard surgical treatment of choice for UC. With the advent of laparoscopic techniques for colorectal surgery, ileal-pouch anal anastomosis has also been performed laparoscopically. This paper reviews the history and current trends in laparoscopic surgery for UC. The accumulation of experience and improvement of laparoscopic devices have shifted the paradigm of UC surgery towards laparoscopic surgery over the past decade. Although laparoscopic surgery requires a longer operation, it provides significantly better short and long-term outcomes. The short-term benefits of laparoscopic surgery over open surgery include shorter hospital stays and fasting times, as well as better cosmesis. The long-term benefits of laparoscopy include better fecundity in young females. Some surgeons favor laparoscopic surgery even for severe acute colitis. More efforts are being made to develop newer laparoscopic methods, such as reduced port surgery, including single incision laparoscopic surgery and robotic surgery.
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Affiliation(s)
- Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
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Total abdominal colectomy for severe ulcerative colitis: does the laparoscopic approach really have benefit? Surg Endosc 2013; 28:617-25. [PMID: 24196546 DOI: 10.1007/s00464-013-3218-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 09/09/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is still unknown to what extent the reported morbidity and recovery benefits of laparoscopic total abdominal colectomy (TAC) for severe ulcerative colitis (UC) are associated with patient selection bias. This study aimed to evaluate whether laparoscopic TAC has any advantages over open surgery after control for perioperative confounding factors. METHODS Patients undergoing TAC for UC during 2006-2010 were identified. Demographics, disease characteristics, and perioperative outcomes were compared between laparoscopic and open TAC. Postoperative recovery and 30-day complications were further assessed by covariate-adjusted multivariate regression models. The outcomes of different laparoscopic techniques were compared. A subgroup analysis including surgeons who routinely used both laparoscopic and open techniques was also performed. RESULTS Of the 412 eligible patients, the 197 patients undergoing laparoscopic TAC were significantly younger and had a decreased Charlson Comorbidity Index and ASA score, increased hemoglobin and serum albumin levels, and a smaller proportion of extensive colitis and urgent cases. Unadjusted analyses showed that intraoperative morbidity, postoperative mortality, and rates for readmission and reoperation were similar. Laparoscopic TAC was associated with a longer operative time but a decrease in blood loss, overall morbidity, ileus, and thromboembolism, as well as a faster return to bowel function and a shorter hospital stay. After covariate adjustments, laparoscopic surgery remained associated with a reduction in the time to stoma function, incidence of postoperative ileus, and hospital stay compared with open TAC. The rates of postoperative morbidity, readmission, and reoperation did not differ regardless whether the conventional multitrocar technique, hand-assisted procedure, or single-incision technique was used. Laparoscopic TAC among surgeons using both open and laparoscopic techniques was associated with recovery benefits similar to those observed in the overall study population. CONCLUSION The data suggest that laparoscopic TAC retains recovery advantages over open surgery even after adjustments for confounders.
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Singh P, Bhangu A, Nicholls RJ, Tekkis P. A systematic review and meta-analysis of laparoscopic vs open restorative proctocolectomy. Colorectal Dis 2013; 15:e340-51. [PMID: 23560590 DOI: 10.1111/codi.12231] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/15/2012] [Indexed: 12/16/2022]
Abstract
AIM The benefits of a laparoscopic approach to restorative proctocolectomy (RPC) are controversial. The aim of this meta-analysis was to compare the outcome following laparoscopic and open RPC, with particular attention to adverse events and long-term function. METHOD A systematic search of the MEDLINE, EMBASE and Ovid databases was performed for studies published until March 2012. The primary end-point was long-term function. Secondary end-points were intra-operative details, short-term postoperative outcome and postoperative adverse events. Weighted mean difference (WMD) and odds ratio (OR) were calculated using fixed/random effect meta-analytic techniques. RESULTS The final analysis included 27 comparative studies of 2428 patients, of whom 1097 (45.1%) underwent laparoscopic surgery. A laparoscopic approach was associated with a significantly longer operation time (WMD 70.1 min, P < 0.001), shorter length of hospital stay (WMD -1.00 day, P < 0.001), reduced intra-operative blood loss (WMD -89.10 ml, P < 0.001) and a lower incidence of wound infection (OR 0.60, P < 0.005). No significant differences were observed in the rate of pouch failure. Although there was no significant difference in the number of daily bowel movements (OR 0.04, P = 0.950), laparoscopic surgery led to fewer nocturnal bowel movements (WMD -1.14, P < 0.001) and reduced pad usage during the day (OR 0.22, P < 0.001) and night (OR 0.33, P < 0.001). The post hoc power to detect differences in adverse event rates ranged from 5% to 42%. CONCLUSION Laparoscopic and open approaches to RPC produced equivalent adverse event rates and long-term functional results. However, the present evidence is underpowered to detect true differences in adverse event rates.
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Affiliation(s)
- P Singh
- Faculty of Medicine, Imperial College London, London, UK
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Bartels SAL, Gardenbroek TJ, Ubbink DT, Buskens CJ, Tanis PJ, Bemelman WA. Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 2013; 100:726-33. [PMID: 23355043 DOI: 10.1002/bjs.9061] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND This review compared short-term outcomes after laparoscopic versus open subtotal colectomy for acute, colitis medically refractory. METHODS A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases. Overall study quality was assessed by the modified Methodological Index for Non-Randomized Studies (MINORS). Meta-analysis was performed for conversion, reoperation, wound infection, ileus, gastrointestinal bleeding, intra-abdominal abscess, postoperative length of stay and mortality. RESULTS The search identified nine non-randomized studies: six cohort studies and three case-matched series, comprising 966 patients in total. The pooled conversion rate was 5·5 (95 per cent confidence interval (c.i.) 3·6 to 8·4) per cent in the laparoscopic group. The pooled risk ratio of wound infection was 0·60 (95 per cent c.i. 0·38 to 0·95; P = 0·03) and that of intra-abdominal abscess was 0·27 (0·08 to 0·91; P = 0·04), both in favour of laparoscopic surgery. Pooled risk ratios for other complications showed no significant differences. Length of stay was significantly shorter after laparoscopic subtotal colectomy, with a pooled mean difference of 3·17 (95 per cent c.i. 2·37 to 3·98) days (P < 0·001). CONCLUSION Where the procedure can be completed laparoscopically, there may be short-term benefits over open colectomy for colitis. These results cannot be generalized to critically ill patients in need of an emergency subtotal colectomy.
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Affiliation(s)
- S A L Bartels
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, D'Haens G, D'Hoore A, Mantzaris G, Novacek G, Oresland T, Reinisch W, Sans M, Stange E, Vermeire S, Travis S, Van Assche G. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis 2012; 6:991-1030. [PMID: 23040451 DOI: 10.1016/j.crohns.2012.09.002] [Citation(s) in RCA: 683] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Axel Dignass
- Department of Medicine 1, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt/Main, Germany.
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Abstract
Severe colitis is a well-defined condition that can develop in patients afflicted with ulcerative colitis, but typically responds to a variety of medical therapies. Operative intervention is warranted when massive hemorrhage, perforation, or peritonitis complicates the clinical scenario or medical therapy fails to control the disease. Of the operative options, total/subtotal colectomy and end ileostomy is the usual procedure of choice especially if the operation can be performed through a laparoscopic approach.
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Affiliation(s)
- Scott A Strong
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio. USA.
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Abstract
Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed.
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Affiliation(s)
- Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. USA.
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Efthymiou M, Taylor ACF, Kamm MA. Cancer surveillance strategies in ulcerative colitis: the need for modernization. Inflamm Bowel Dis 2011; 17:1800-13. [PMID: 21089179 DOI: 10.1002/ibd.21540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The risk of colorectal cancer is increased in patients with long-standing ulcerative colitis. Traditional surveillance has centered around regular standard white-light colonoscopy, with multiple biopsies aimed at detecting dysplasia or the identification of early cancer. This has resulted in only a modest reduction in cancer incidence and mortality. A better understanding of disease risk factors may allow endoscopic resources to be more focused on patients at higher risk. In addition, advanced endoscopic techniques have the potential to improve dysplasia detection, minimize the need for routine biopsies, and allow for the removal of dysplastic lesions, avoiding the need for surgery. Techniques such as magnification colonoscopy, chromoendoscopy, narrow band imaging, autofluorescence, and confocal endomicroscopy may all have a role to play in improving the benefits of endoscopic surveillance. Revised endoscopic surveillance strategies are proposed, incorporating aspects of risk stratification, a well-established practice in noncolitis-related colorectal cancer screening, and some of these new technologies.
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Affiliation(s)
- Marios Efthymiou
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
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Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy? Surg Endosc 2011; 25:3294-9. [PMID: 21533970 DOI: 10.1007/s00464-011-1707-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/28/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to compare outcomes of laparoscopic and open completion proctectomy (CP) and ileal-pouch anal anastomosis (IPAA) after a previous laparoscopic subtotal colectomy (STC). METHODS From a prospectively maintained ileal pouch database, outcomes for patients who underwent laparoscopic CP after laparoscopic STC (LSTC-LCP group) for ulcerative or indeterminate colitis were compared to those for patients who underwent open CP (LSTC-OCP group). A control group of open CP after open STC (OSTC-OCP group) was case-matched to LSTC-OCP at a ratio of 1:2 for age at surgery, gender, body mass index (BMI), year of operation, and American Society of Anesthesiologists (ASA) classification. Demographics, perioperative data, and pouch function were compared. Quality of life was evaluated using the Cleveland Global Quality of Life Scale (CGQL). RESULTS Between 1997 and 2009, 47 patients underwent LSTC followed by LCP (LSTC-LCP), and 48 patients underwent OCP after LSTC (LSTC-OCP); the latter group was matched to 96 open-open patients (OSTC-OCP). There were no significant differences in demographic and preoperative data among the three groups, except that the OSTC-OCP group patients were younger. Postoperative morbidity, pouch function, and CGQL were similar. LSTC-LCP patients had lower estimated blood loss (EBL) (p < 0.001), less commonly described intraoperative adhesiolysis (p < 0.001), reduced length of hospital stay (LOS) (p = 0.002) but longer operating time (p = 0.001) at CP/IPAA when compared with open-open patients. For patients with previous LSTC, LCP was associated with less commonly described intraoperative adhesiolysis (p = 0.003) and shorter LOS (p = 0.003) than OCP but a longer operating time (p = 0.036). CONCLUSIONS Laparoscopic CP and IPAA can be performed with safety comparable to that of open surgery after previous laparoscopic STC. The laparoscopic approach is associated with advantages including reduced intraoperative blood loss and earlier recovery as demonstrated by shorter length of hospital stay.
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Laparoscopic Subtotal Colectomy for Acute or Severe Colitis With Double-end Ileo-sigmoidostomy in Right Iliac Fossa. Surg Laparosc Endosc Percutan Tech 2010; 20:27-9. [DOI: 10.1097/sle.0b013e3181cda0f8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lefevre JH, Bretagnol F, Ouaïssi M, Taleb P, Alves A, Panis Y. Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients. Surg Endosc 2008; 23:166-73. [DOI: 10.1007/s00464-008-0121-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 07/04/2008] [Accepted: 07/24/2008] [Indexed: 02/03/2023]
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