Display options
Cite
Yellinek S, Gilshtein H, Krizzuk D, et al. Re-operation surgery following IPAA: is there a role for laparoscopy?. Surg Endosc. 2020;35(4):1591-1596doi: 10.1007/s00464-020-07537-0.
Yellinek, S., Gilshtein, H., Krizzuk, D., & Wexner, S. D. (2021). Re-operation surgery following IPAA: is there a role for laparoscopy?. Surgical endoscopy, 35(4), 1591-1596. https://doi.org/10.1007/s00464-020-07537-0
Yellinek, Shlomo, et al. "Re-operation surgery following IPAA: is there a role for laparoscopy?." Surgical endoscopy vol. 35,4 (2021): 1591-1596. doi: https://doi.org/10.1007/s00464-020-07537-0
Yellinek S, Gilshtein H, Krizzuk D, Wexner SD. Re-operation surgery following IPAA: is there a role for laparoscopy?. Surg Endosc. 2021 Apr;35(4):1591-1596. doi: 10.1007/s00464-020-07537-0. Epub 2020 Apr 07. PMID: 32266546.
Copy Download .nbib Format: NLM
Share it on

Surg Endosc. 2021 Apr;35(4):1591-1596. doi: 10.1007/s00464-020-07537-0. Epub 2020 Apr 07.

Re-operation surgery following IPAA: is there a role for laparoscopy?.

Surgical endoscopy

Shlomo Yellinek, Hayim Gilshtein, Dimitri Krizzuk, Steven D Wexner

Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
  2. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA. [email protected].

PMID: 32266546 DOI: 10.1007/s00464-020-07537-0

Abstract

BACKGROUND: Restorative proctocolectomy with ileal J pouch anal anastomosis (IPAA) has become the standard of care for mucosal ulcerative colitis and Familial Adenomatous Polyposis. Some patients require re-operation, including pouch revision, advancement, or excision. Re-operative procedures are technically demanding and usually performed only by experienced colorectal surgeons in a small number of referral centers. There is a paucity of data regarding feasibility, safety, and outcomes of laparoscopic re-operative IPAA surgery. This study aimed to determine the safety and feasibility of laparoscopic approach for re-operative IPAA, trans-abdominal surgery.

METHODS: Retrospective analysis of IRB-approved prospective database for patients who underwent trans-abdominal re-operative IPAA from 2011 to 2018. Patient demographics and operative reports were reviewed to classify type of re-operation into pouch excision, revision, or advancement and further classify as laparoscopic, laparoscopic converted to open, or open surgery. Main outcome measures were post-operative morbidity and mortality.

RESULTS: Seventy-six patients met the inclusion criteria: 19 underwent attempted laparoscopic re-operative IPAA surgery, 12 of whom underwent successful laparoscopic surgery while 7 were converted to laparotomy, for an overall laparoscopic intent to treat 63% success rate. The remaining operations (n = 57) were performed through midline laparotomy. Length of stay (LOS) for patients who underwent laparoscopic surgery was significantly shorter (5.5 vs 9.7 days, p < 0.001) as were abdominal superficial surgical site infections (SSI) (0% vs 18%, p < 0.001) and deep SSI (0% vs 17%, p < 0.001). Laparotomy was performed by 6 colorectal surgeons at our institution while laparoscopy was successfully performed only by the senior author. There was no significant difference in overall complications, re-admission, re-operation, or mortality.

CONCLUSION: Re-operative, trans-abdominal, laparoscopic IPAA is both feasible and safe and has clear benefits compared to laparotomy in terms of LOS and superficial and deep SSI. However, this approach needs to be undertaken only by very experienced, high-volume laparoscopic IPAA surgeons.

Keywords: Familial adenomatous polyposis; IPAA; Ileal J pouch anal anastomosis; Laparoscopy; Mucosal ulcerative colitis; Re-operative IPAA

References

  1. Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685 - PubMed
  2. Ozdemir Y, Kiran RP, Erem HH et al (2014) Functional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population. J Am Coll Surg 218:328–335 - PubMed
  3. Fazio VW, Ziv Y, Church JM et al (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222:120–127 - PubMed
  4. Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85:800–803 - PubMed
  5. Fazio VW, O’Riordain MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–586 - PubMed
  6. Tekkis PP, Lovegrove RE, Tilney HS et al (2010) Long-term failure and function after restorative proctocolectomy - a multi-center study of patients from the UK National Ileal Pouch Registry. Colorectal Dis 12:433–441 - PubMed
  7. Nisar PJ, Kiran RP, Shen B, Remzi FH, Fazio VW (2011) Factors associated with ileoanal pouch failure in patients developing early or late pouch-related fistula. Dis Colon Rectum 54:446–453 - PubMed
  8. Manilich E, Remzi FH, Fazio VW, Church JM, Kiran RP (2012) Prognostic modeling of preoperative risk factors of pouch failure. Dis Colon Rectum 55:393–399 - PubMed
  9. Tekkis PP, Fazio VW, Remzi F, Heriot AG, Manilich E, Strong SA (2005) Risk factors associated with ileal pouch-related fistula following restorative proctocolectomy. Br J Surg 92:1270–1276 - PubMed
  10. Fazio VW, Tekkis PP, Remzi F et al (2003) Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 238:605–617 - PubMed
  11. Melton GB, Fazio VW, Kiran RP et al (2008) Long-term outcomes with ileal pouch-anal anastomosis and Crohn’s disease: pouch retention and implications of delayed diagnosis. Ann Surg 248:608–616 - PubMed
  12. Shen B, Fazio VW, Remzi FH et al (2006) Risk factors for clinical phenotypes of Crohn’s disease of the ileal pouch. Am J Gastroenterol 101:2760–2768 - PubMed
  13. Lightner AL, Shogan BD, Mathis KL et al (2018) Revisional and reconstructive surgery for failing IPAA is associated with good function and pouch salvage in highly selected patients. Dis Colon Rectum 61:920–930 - PubMed
  14. Remzi FH, Aytac E, Ashburn J et al (2015) Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: lessons learned over 500 patients. Ann Surg 262:675–682 - PubMed
  15. Pellino G, Selvaggi F (2015) Outcomes of salvage surgery for ileal pouch complications and dysfunctions. The experience of a referral center and review of literature. J Crohns Colitis 9:548–557 - PubMed
  16. Shawki S, Belizon A, Person B, Weiss EG, Sands DR, Wexner SD (2009) What are the outcomes of reoperative restorative proctocolectomy and ileal pouch-anal anastomosis surgery? Dis Colon Rectum 52:884–890 - PubMed
  17. Remzi FH, Fazio VW, Kirat HT, Wu JS, Lavery IC, Kiran RP (2009) Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch. Dis Colon Rectum 52:198–204 - PubMed
  18. Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238:229–234 - PubMed
  19. Baixauli J, Delaney CP, Wu JS, Remzi FH, Lavery IC, Fazio VW (2004) Functional outcome and quality of life after repeat ileal pouch anal anastomosis for complications of ileoanal surgery. Dis Colon Rectum 47:2–11 - PubMed
  20. Lightner AL, Dattani S, Dozois EJ, Moncrief SB, Pemberton JH, Mathis L (2017) Pouch excision: indications and outcomes. Colorectal Dis 19:912–916 - PubMed
  21. Yang C, Wexner SD, Safar B, Jobanputra S, Jin H, Li VK, Nogueras JJ, Weiss EG, Sands DR (2009) Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc 23(11):2454–2458. https://doi.org/10.1007/s00464-009-0414-6 - PubMed
  22. Larson DW (2014) Revision IPAA: Strategies for success. J Gastrointest Surg 18:1236–1237 - PubMed
  23. Holubar SD, Neary P, Aiello A et al (2019) Ileal pouch revision vs excision: short-term (30-day) outcomes from the National Surgical Quality Improvement Program. Colorectal Dis 21(2):209–218 - PubMed
  24. Baek S-J, Dozois EJ, Mathis KL et al (2016) Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience. Tech Coloproctol 20:369–374 - PubMed
  25. Marcello PW, Milsom JW, Wong SK et al (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608 - PubMed
  26. Larson DW, Dozois EJ, Piotrowicz K et al (2005) Laparoscopic-assisted vs open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 48:1845–1850 - PubMed
  27. Hata K, Kazama S, Nozawa H et al (2015) Laparoscopic surgery for ulcerative colitis: a review of the literature. Surg Today 45:933–938 - PubMed
  28. Sardinha TC, Wexner SD (1998) Laparoscopy for inflammatory bowel disease: pros and cons. World J Surg 22:370–374 - PubMed
  29. Schmitt SL, Cohen SM, Wexner SD, Nogueras JJ, Jagelman DG (1994) Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization? Int J Colorectal Dis 9:134–137 - PubMed
  30. Yang C, Wexner SD, Safar B, Jobanputra S, Jin H, Li VK, Nogueras JJ, Weiss EG, Sands DR (2009) Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc 23(11):2454–2458 - PubMed

MeSH terms

Publication Types