David B Stewart1, Evangelos Messaris. 1. Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, H137, Hershey, PA 17033, USA. dstewart@hmc.psu.edu
Abstract
BACKGROUND: The role of single-site laparoscopy (SSL) for the treatment of ileocolic Crohn's disease complicated by an abscess, a phlegmon, or fistulizing disease has not been thoroughly assessed. METHODS: A prospectively maintained database of SSL surgeries performed between October 2010 and March 2011 was reviewed. Consecutive patients with ileocolic Crohn's disease complicated by a paracolic abscess, a phlegmon, or a fistula were included for analysis. Data recorded included demographic information, body mass index (BMI), estimated blood loss (EBL), length of surgery, rate of conversion to standard laparoscopic surgery or open surgery, length of hospital stay, and rate of complications. RESULTS: A total of six patients were identified. Complications from Crohn's disease included four (66%) patients who developed a paracolic abscess that required drainage upon admission, one (16%) patient who developed a phlegmon, and one (16%) patient who developed an enterocutaneous fistula. Mean age of the study population was 25 years, with a mean BMI of 21 and a mean ASA score of 3. Five (83%) of the patients were immunosuppressed with high-dose steroids. Mean operative time was 160 min, with a median EBL of 60 mL. One patient required the insertion of an additional trocar, whereas there were no conversions to laparotomy. Four (66%) patients required diversion with a loop ileostomy. Median time to flatus was 1 day. All patients tolerated a diet on the day of surgery, with a median length of stay of 3 days. There were no deaths and no complications related to bleeding, organ injury, surgical site infections, or anastomotic leaks. CONCLUSIONS: A single-site laparoscopic approach for complicated ileocolic Crohn's disease can be performed safely, with short lengths of hospital stay and with a low rate of complications. A multicenter study would be beneficial to validate these findings.
BACKGROUND: The role of single-site laparoscopy (SSL) for the treatment of ileocolic Crohn's disease complicated by an abscess, a phlegmon, or fistulizing disease has not been thoroughly assessed. METHODS: A prospectively maintained database of SSL surgeries performed between October 2010 and March 2011 was reviewed. Consecutive patients with ileocolic Crohn's disease complicated by a paracolic abscess, a phlegmon, or a fistula were included for analysis. Data recorded included demographic information, body mass index (BMI), estimated blood loss (EBL), length of surgery, rate of conversion to standard laparoscopic surgery or open surgery, length of hospital stay, and rate of complications. RESULTS: A total of six patients were identified. Complications from Crohn's disease included four (66%) patients who developed a paracolic abscess that required drainage upon admission, one (16%) patient who developed a phlegmon, and one (16%) patient who developed an enterocutaneous fistula. Mean age of the study population was 25 years, with a mean BMI of 21 and a mean ASA score of 3. Five (83%) of the patients were immunosuppressed with high-dose steroids. Mean operative time was 160 min, with a median EBL of 60 mL. One patient required the insertion of an additional trocar, whereas there were no conversions to laparotomy. Four (66%) patients required diversion with a loop ileostomy. Median time to flatus was 1 day. All patients tolerated a diet on the day of surgery, with a median length of stay of 3 days. There were no deaths and no complications related to bleeding, organ injury, surgical site infections, or anastomotic leaks. CONCLUSIONS: A single-site laparoscopic approach for complicated ileocolic Crohn's disease can be performed safely, with short lengths of hospital stay and with a low rate of complications. A multicenter study would be beneficial to validate these findings.
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