Search

Background: Although single-incision laparoscopic (SIL) ileal pouch-anal anastomosis (IPAA) has been shown to be feasible and safe, outcomes have not been compared with the standard laparoscopic-assisted (LA) procedures. The purpose of this study was to compare the two techniques in children with chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP)., Subjects and Methods: Children ≤ 18 years of age who underwent SIL and LA IPAA between 2000 and 2013 at our institution were identified. Patient information was obtained retrospectively from patients' medical records and compared between approaches. RESULTS for operative time and postoperative length of stay were stratified by number of stages (one, two, or three), and postoperative complications were stratified by diagnosis (CUC or FAP)., Results: Children who underwent SIL IPAA (n=19) and LA IPAA (n=62) were not significantly different in age, gender, diagnosis, anti-tumor necrosis factor-α antibody use, staged approach, and stapled versus mucosectomy with hand-sewn anastomosis. SIL and LA IPAA had equivalent operative times for two- and three-stage procedures, but operative time for one-stage procedures was shorter with SIL (308 versus 355 minutes; P<.001). Median length of stay was shorter following SIL for all patients (4 versus 7 days; P<.001) and, specifically, for two-stage patients (4 versus 6 days; P=.009). There were no significant differences in complications between SIL and LA., Conclusions: SIL IPAA is a safe alternative to LA IPAA for children with CUC or FAP and may reduce postoperative length of stay without affecting short-term postoperative morbidity. Additional studies are needed to determine if there are long-term benefits.

Background: Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is the operative procedure of choice for familial adenomatous polyposis (FAP) patients. We review 24years of operative experience and outcomes in pediatric patients with FAP., Methods: Patients with FAP, age<20years, presenting to a single institution between 1987 and 2011 were included. Operative technique and outcomes were reviewed retrospectively. Primary outcomes included postoperative complications (30days), long-term bowel function, and polyp recurrence at the anal anastomosis., Results: 95 patients with FAP underwent IPAA. Mean age at IPAA was 15.5years with a mean follow-up of 7.6years. 29 patients underwent 1-stage IPAA, 65 patients had a two-stage IPAA, and 1 patient underwent a 3-stage procedure. 67 patients had an open procedure, 25 underwent a laparoscopic approach, and more recently 3 patients underwent single incision laparoscopic IPAA. Patients with 1-stage IPAA demonstrate better long term bowel control vs. 2-stage IPAA patients (10.7% vs. 36.0% occasional incontinence, p=0.018). However, 1-stage IPAA patients suffered increased short-term complications, such as anastomotic leak (17.2% vs. 0%, p=0.002) and reoperation (20.7% vs. 4.6%, p=0.02) compared to 2-stage IPAA. Anal anastomosis polyp recurrence occurred in 22.7% of 1-stage patients and 10.0% of 2-stage patients. Short-term complications, polyp recurrence, or long-term continence were equivalent between open and laparoscopic cases., Conclusion: Single-stage IPAA in children with FAP is associated with better bowel control but increased anastomotic leak, reoperative rate, and polyp recurrence. In experienced hands, laparoscopic IPAA is equivocal to open IPAA., (Copyright © 2014 Elsevier Inc. All rights reserved.)