Whether the reported theoretical benefits of single-port laparoscopic (SPL) approach can be converted to superior clinical outcomes is still unknown for ulcerative colitis (UC) patients undergoing ...second-stage proctectomy. This study aimed to compare the short-term postoperative and long-term pouch-related functional outcomes of SPL, multiport laparoscopic (MPL), and direct view (DV) completion proctectomy with ileal-pouch anal anastomosis (CP/IPAA).
Patients who underwent either SPL, MPL, or under DV CP/IPAA for UC between August 2009 and August 2014 were identified from an institutional review board-approved, prospectively maintained institutional database and reviewed. Demographics, patient characteristics, short-term and long-term complications, and morbidity were compared between the 3 groups. Multivariate logistic or Cox regression analysis was conducted for covariate adjustments.
Groups (SPL: n=36; MPL: n=67; DV: n=97) were comparable in terms of preoperative characteristics and demographics except for age. The SPL group was associated with reduced estimated blood loss, reduced length of stay compared with the MPL and DV groups, and shorter operating time compared with the MPL group (P<0.001). Similar short-term postoperative and long-term pouch-related functional outcomes were noted without significant differences in quality of life scores among the 3 groups.
SPL CP/IPAA for UC can be safely performed with superior short-term outcomes such as reduced intraoperative blood loss and length of hospital stay compared with MPL and under direct view approaches, and shorter operating time compared with MPL.
Background
In this study, we aimed to compare short‐ and long‐term outcomes between laparoscopic totally extraperitoneal (L‐TEP) and robotic transabdominal preperitoneal (R‐TAPP) inguinal hernia ...repair.
Methods
Patients were classified into two groups: L‐TEP and R‐TAPP. The groups were case‐matched in a 1:1 ratio based on age, gender, and body mass index (BMI).
Results
Out of 86 patients, 43 patients were matched in each group based on the study criteria. Demographics were comparable between the groups. Operative time was significantly longer for the R‐TAPP compared to L‐TEP (129.1 ± 47.2 min vs 92.5 ± 28.3 min; P < .001). VAS scores at 24 hours after surgery were significantly higher in the L‐TEP compared to R‐TAPP (36.8 ± 20.1 vs 20.3 ± 18.7; P < .001). Total hospital costs were 4778$ for R‐TAPP and 3852$ for L‐TEP.
Conclusion
The current study demonstrates similar long‐term postoperative outcomes and recurrence rates between robotic and laparoscopic inguinal hernia repair in a case‐matched fashion.
•This video shows our technique on fully robotic Ivor-Lewis esophagectomy with intrathoracic robot-sewn anastomosis.•Robotic Ivor-Lewis esophagectomy with intrathoracic anastomosis is a safe and ...feasible technique for esophageal cancer.•Robotic approach provides superior visualization and ability to perform precise intracorporeal suturing in reconstructing.
Purpose
The aim of this study was to evaluate the impact of various factors on 30-day postoperative morbidity in patients who underwent colorectal surgery (CRS) for colovesical fistula (CVF) in the ...elective and emergency settings.
Methods
Patients who underwent CRS for CVF between 2005 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database by using current procedural terminology codes. Demographics, perioperative, and operative factors were assessed and compared between two groups classified according to the presence or absence of postoperative complications.
Results
Five hundred twelve patients met the inclusion criteria mean age of 61.4 (±14.7) years, female 214 (42%). Etiology of fistula was diverticulitis
N
= 438 (85.5%), colon cancer
N
= 39 (7.6%), and Crohn’s disease
N
= 35 (6.8%). One hundred fifty-two procedures (29.7%) were performed laparoscopically. In 186 patients (36%), no bladder intervention was performed. One hundred forty-nine patients (29.1%) had at least one postoperative complication. Patients who developed complication were older (
P
= <0.001), more often female (
P
= <0.001), hypertensive (
P
= 0.005), anemic (
P
= <0.001), preoperatively transfused (
P
= 0.02), and with class 2–3 wound classification (
P
= 0.01). Independent risk factors affecting morbidity were increased age odds ratio (OR) 1.23 (1.03–1.47),
P
= 0.01, decreased hematocrit level OR 3.04(1.83–5.06),
P
< 0.0001, and open approach OR 2.56 (1.35–4.84),
P
= 0.003.
Conclusions
Morbidity for CVF remains high. Lower preoperative hematocrit level and increased age were associated with higher risk of complication. Laparoscopic surgery may be preferable when possible as morbidity is less with this approach.
Background
Introduction of the da Vinci Xi system has facilitated the use of robotics in colorectal surgery. Nevertheless, data on the outcomes of robotic surgery for the treatment of colonic ...diverticulitis have remained scarce.
Methods
Patient demographics, clinical characteristics, and perioperative outcomes of the patients undergoing totally robotic with the da Vinci Xi system or laparoscopic surgery for left‐sided colonic diverticulitis (LCD) were compared.
Results
Laparoscopic and robotic groups included 22 and 20 patients, respectively. There were no significant differences between the two groups in terms of patient demographics, clinical characteristics, operative time, and postoperative complications. There were three conversions in the laparoscopy group and no conversion in the robotic group (P = 0.23). Conversion to open surgery was associated with postoperative morbidity (P = 0.02).
Conclusion
Robotic surgery is an applicable alternative for the treatment of LCD. Robotic approach may potentially lower the risk of operative morbidity by reducing the requirement of conversion.
The aim of this study is to compare short-term outcomes of laparoscopic versus open Hartmann reversal.
Patients who underwent Hartmann reversal between January 2005 and September 2014 were identified ...and matched for age, sex, body mass index, American Society of Anesthesiologists score, and creation of diverting ileostomy to open counterparts. Patient characteristics and postoperative outcomes (30 d) were evaluated.
Eighteen patients with laparoscopic Hartmann reversal were matched to 18 open patients. There were no differences between laparoscopic versus open groups in terms of operative time (157.7±52.2 vs. 151.5±49.3 min, P>0.05) or overall complication rates 6 (33.3%) vs. 6 (33.3%) (P>0.05). No anastomotic leaks or mortality occurred in either group. However, the laparoscopic group was associated with significantly decreased estimated blood loss (114±103 vs. 217±125 mL, P<0.05), faster return of bowel function (3.2±0.6 vs. 4±0.6 d, P<0.05), and reduced hospital stay (5.4±3.1 vs. 8.3±4.8 d, P<0.05).
Laparoscopic Hartmann reversal can be safely performed with better short-term outcomes in carefully selected patients.
Background
This study aimed to compare perioperative outcomes of patients undergoing robotic, laparoscopic, and open colectomy using a procedure‐targeted database.
Methods
Retrospective review of ...patients undergoing elective colectomy in 2013 was conducted using the procedure‐targeted database of the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP). Robotic, laparoscopic, and open groups were matched (1:1:1) based on age, gender, body mass index, surgical procedure, diagnosis and ASA classification. Demographics, comorbidities, and short‐term (30 day) outcomes were compared.
Results
Out of 12 790 patients, 387 fulfilled criteria per group after matching. Univariate comparison showed operating time was longer (P < 0.001) and hospital stay was shorter (P < 0.001) in the robotic group. Morbidity (P < 0.001), superficial SSI (P < 0.001), bleeding requiring transfusion (P < 0.001), ventilator dependency (P = 0.003), and ileus (P < 0.001) rates were lower in the robotic group. After adjusting for confounders, outcomes were comparable between the groups except hospital stay which was shorter in the robotic group (P < 0.001).
Conclusions
ACS‐NSQIP data demonstrated several short‐term advantages of robotic surgery compared with laparoscopic and open surgery.
Introduction
Cytoreductive surgery (CRS) with subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising modality to treat and prevent peritoneal metastases. However, this treatment ...is associated with signficant morbidity and mortality. Whether or not CRS with HIPEC interferes with anastomotic healing has also been debated. This study was designed to investigate the effects of mitomycin C, cisplatin, oxaliplatin, and doxorubicin used in HIPEC treatment on colonic anastomosis healing in a rat model.
Methods
Sixty Wistar albino rats were employed in the study. Sigmoid resection and end-to-end colorectal anastomosis was performed in all rats. Group 1 rats underwent the surgical procedure alone, while group 2 rats were given hyperthermic intraperitoneal lavage with heated saline following surgery. Groups 3, 4, 5, and 6 had surgery with concomitant HIPEC treatment with mitomycin C, cisplatin, oxaliplatin, and doxorubicin, respectively. Anastomotic bursting pressures and hydroxyproline levels were evaluated.
Results
Regarding the hydroxyproline levels, groups 1 and 2 showed significantly higher values than other groups (p<0.001). However, there was no significant difference between the HIPEC treatment groups (groups 3, 4, 5, and 6) (p>0.05). When groups were compared regarding bursting pressure values, no significant differences were observed (p = 0.81).
Conclusions
This study demonstrated that the HIPEC procedure with mitomycin C, cisplatin, oxaliplatin and doxorubicin had negative effects on hydroxyproline levels, but had no detrimental effect on anastomotic bursting pressure in a rat model.
