Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis
Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcome...
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MDPI AG
2020-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/10/3382 |
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| author | Gianluca Matteo Sampietro Francesco Colombo Fabio Corsi |
| author_facet | Gianluca Matteo Sampietro Francesco Colombo Fabio Corsi |
| author_sort | Gianluca Matteo Sampietro |
| collection | DOAJ |
| description | Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still a topic of improvement. We designed a standardized 10-steps, sequential approach to laparoscopic colectomy, based on the philosophy of the “critical view of safety”, with the aim to improve perioperative outcomes (operative duration, estimated blood loss, complications, readmissions, reoperations, and length of postoperative stay). We performed a retrospective cohort study using data from a prospectively maintained clinical database. We included all the consecutive, unselected patients undergoing laparoscopic subtotal colectomy (SCo) for IBD between 2008 and 2019 in a tertiary IBD Italian Centre. Starting from 2015, we regularly adopted the novel Sequential Approach for a Critical-View Colectomy (SACCo) technique. We included 59 (40.6%) patients treated with different laparoscopic approaches, and 86 patients (59.4%) operated on by the SACCo procedure. The mean operating time was significantly shorter for the SACCo group (144 vs. 224 min; <i>p</i> < 0.0001). The SACCo technique presented a trend to fewer major complications (6.8% vs. 8.3%), less readmissions (2.3% vs. 13.5%; <i>p</i> = 0.01), and shorter postoperative hospital stay (7.2 vs. 8.8 days; <i>p</i> = 0.003). Laparoscopic SACCo-technique is a safe and reproducible surgical approach for acute severe colitis and may improve the outcomes of this demanding procedure. |
| first_indexed | 2024-03-10T15:26:50Z |
| format | Article |
| id | doaj.art-b17a80e9d0eb4a0ea32f2c43be2a5692 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T15:26:50Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b17a80e9d0eb4a0ea32f2c43be2a56922023-11-20T18:01:34ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-01910338210.3390/jcm9103382Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe ColitisGianluca Matteo Sampietro0Francesco Colombo1Fabio Corsi2Division of Surgery, ASST Rhodense, Rho Memorial Hospital, 20017 Milano, ItalyDivision of Surgery, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, 20157 Milano, ItalyDepartment of Biomedical and Clinical Sciences, University of Milano, 20157 Milano, ItalyAcute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still a topic of improvement. We designed a standardized 10-steps, sequential approach to laparoscopic colectomy, based on the philosophy of the “critical view of safety”, with the aim to improve perioperative outcomes (operative duration, estimated blood loss, complications, readmissions, reoperations, and length of postoperative stay). We performed a retrospective cohort study using data from a prospectively maintained clinical database. We included all the consecutive, unselected patients undergoing laparoscopic subtotal colectomy (SCo) for IBD between 2008 and 2019 in a tertiary IBD Italian Centre. Starting from 2015, we regularly adopted the novel Sequential Approach for a Critical-View Colectomy (SACCo) technique. We included 59 (40.6%) patients treated with different laparoscopic approaches, and 86 patients (59.4%) operated on by the SACCo procedure. The mean operating time was significantly shorter for the SACCo group (144 vs. 224 min; <i>p</i> < 0.0001). The SACCo technique presented a trend to fewer major complications (6.8% vs. 8.3%), less readmissions (2.3% vs. 13.5%; <i>p</i> = 0.01), and shorter postoperative hospital stay (7.2 vs. 8.8 days; <i>p</i> = 0.003). Laparoscopic SACCo-technique is a safe and reproducible surgical approach for acute severe colitis and may improve the outcomes of this demanding procedure.https://www.mdpi.com/2077-0383/9/10/3382inflammatory bowel diseaseacute severe colitissurgerylaparoscopysurgical techniquecolectomy |
| spellingShingle | Gianluca Matteo Sampietro Francesco Colombo Fabio Corsi Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis Journal of Clinical Medicine inflammatory bowel disease acute severe colitis surgery laparoscopy surgical technique colectomy |
| title | Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis |
| title_full | Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis |
| title_fullStr | Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis |
| title_full_unstemmed | Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis |
| title_short | Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis |
| title_sort | sequential approach for a critical view colectomy sacco a laparoscopic technique to reduce operative time and complications in ibd acute severe colitis |
| topic | inflammatory bowel disease acute severe colitis surgery laparoscopy surgical technique colectomy |
| url | https://www.mdpi.com/2077-0383/9/10/3382 |
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