PTH-044 Single port laparoscopic ileoanal pouch surgery: is this the end of the era of open surgery for ulcerative colitis?

Abstract

Introduction Ileoanal pouch surgery is still being done as an open procedure in many centres in spite of advancement of skills in laparoscopic colorectal surgery. There is plenty of evidence to show the early advantages of laparoscopic colorectal surgery but we believe that even the long term outcomes are likely to be better for pouch surgery. Single port laparoscopic ileoanal pouch surgery through the stoma site is a very attractive option. Method All patients undergoing restorative proctocolectomy or completion proctectomy and ileoanal pouch surgery since 2011 were included. Retrospective analysis performed from a prospectively collected database after confirmation by reviewing patient case notes. All operations were performed laparoscopically by using a multichannel single port device through ileostomy site. Specimen removed from the port site and 20 cm J pouch anastomosed to the anal canal. Results A total of 14 patients (M:F –7:7) with a median age of 27 years (range 17–52 years) underwent single port laparoscopic Ileal pouch anal anastomosis. Their median BMI was 25.75 (range 19.5–40) with a median ASA of 2 (range 1–3). The procedure was completed laparoscopically through the stoma site in all patients except two who required suprapubic incision for division of anorectal junction. The median operating time was 230 mins (range 130–420 mins). The median hospital stay was 4 days (range 3–10). All the patients started taking normal diet by day 2 and stoma started functioning at a median of day 2. Two patients had readmission within 30 days due to stoma related complications. Median interval of reversal of ileostomy was 11 weeks (range 5–20 weeks) with one patient still awaiting reversal as it was done recently. Median stool frequency was 4/24 h, one patient had recurrent pouchitis which settled with probiotics. All patients are satisfied with their recovery, pouch function and continence. Conclusion Ileoanal pouch surgery can be done safely as a single port laparoscopic procedure through the ileostomy site with very good pouch function. Open surgery with long incision is not required for these patients as better results can be achieved by single port laparoscopic surgery. Disclosure of interest None Declared.