Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach?
Background: Ileal pouch anal anastomosis is the treatment of choice for patients with chronic ulcerative colitis and familial adenomatous polyposis undergoing a proctocolectomy and desiring bowel continuity. It is a technically complex operation associated with significant morbidity and may be perfo...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Surgery Open Science |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S258984502200032X |
| _version_ | 1818198086252494848 |
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| author | Dorcas Opoku Alexander Hart, MPH Dakota T. Thompson, MD Catherine G. Tran, MD Mohammed O. Suraju, MD Jeremy Chang, MD Sonja Boatman, MD Alexander Troester, MD Paolo Goffredo, MD Imran Hassan, MD, FACS, FASCRS |
| author_facet | Dorcas Opoku Alexander Hart, MPH Dakota T. Thompson, MD Catherine G. Tran, MD Mohammed O. Suraju, MD Jeremy Chang, MD Sonja Boatman, MD Alexander Troester, MD Paolo Goffredo, MD Imran Hassan, MD, FACS, FASCRS |
| author_sort | Dorcas Opoku |
| collection | DOAJ |
| description | Background: Ileal pouch anal anastomosis is the treatment of choice for patients with chronic ulcerative colitis and familial adenomatous polyposis undergoing a proctocolectomy and desiring bowel continuity. It is a technically complex operation associated with significant morbidity and may be performed by an open, laparoscopic, or robotic approach. However, there is a paucity of data regarding the comparative perioperative outcomes between these 3 techniques outside of institutional studies. Methods: The NSQIP targeted proctectomy data set was used to identify patients who underwent open, laparoscopic, and robotic ileal pouch anal anastomosis between 2016 and 2019. Thirty-day outcomes between different surgical approaches were compared using univariate and multivariable analysis. Results: During the study period, 1,067 open, 971 laparoscopic, and 341 robotic ileal pouch anal anastomosis were performed. The most frequent indications were inflammatory bowel disease (64%), malignancy (18%), and familial adenomatous polyposis (7%). Mean age of the cohort was 43 ± 15 years with 43% female and 76% with body mass index ≤30 kg/m2. Overall morbidity was 26.8% for the entire cohort with 4% anastomotic leak, 6% reoperation, 21% ileus, and 21% readmission rate. After adjusting for available confounders, operative approach was not associated with better short-term outcomes, including length of stay, overall morbidity, anastomotic leak, reoperation, incidence of ileus, and 30-day readmissions. Conclusion: Ileal pouch anal anastomosis continues to be associated with significant postoperative morbidity regardless of operative approach. Patient-related advantages in terms of perioperative outcomes for laparoscopic and robotic platforms compared to open surgery are less pronounced in complex operations such as ileal pouch anal anastomosis. |
| first_indexed | 2024-12-12T02:00:16Z |
| format | Article |
| id | doaj.art-b6e5ab3fe8694395ac92e13d0b79a287 |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-12-12T02:00:16Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-b6e5ab3fe8694395ac92e13d0b79a2872022-12-22T00:42:11ZengElsevierSurgery Open Science2589-84502022-07-0198690Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach?Dorcas Opoku0Alexander Hart, MPH1Dakota T. Thompson, MD2Catherine G. Tran, MD3Mohammed O. Suraju, MD4Jeremy Chang, MD5Sonja Boatman, MD6Alexander Troester, MD7Paolo Goffredo, MD8Imran Hassan, MD, FACS, FASCRS9Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IADepartment of Surgery, University of Iowa Carver College of Medicine, Iowa City, IADepartment of Surgery, University of Iowa Carver College of Medicine, Iowa City, IADepartment of Surgery, University of Iowa Carver College of Medicine, Iowa City, IADepartment of Surgery, University of Iowa Carver College of Medicine, Iowa City, IADepartment of Surgery, University of Iowa Carver College of Medicine, Iowa City, IADepartment of Surgery, University of Minnesota, Minneapolis, MNDepartment of Surgery, University of Minnesota, Minneapolis, MNDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, NYDepartment of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; Corresponding author at: University of Iowa Carver College of Medicine, Department of Surgery, 1500 John Colloton Pavilion, 200 Hawkins Dr, Iowa City, IA 52242.Background: Ileal pouch anal anastomosis is the treatment of choice for patients with chronic ulcerative colitis and familial adenomatous polyposis undergoing a proctocolectomy and desiring bowel continuity. It is a technically complex operation associated with significant morbidity and may be performed by an open, laparoscopic, or robotic approach. However, there is a paucity of data regarding the comparative perioperative outcomes between these 3 techniques outside of institutional studies. Methods: The NSQIP targeted proctectomy data set was used to identify patients who underwent open, laparoscopic, and robotic ileal pouch anal anastomosis between 2016 and 2019. Thirty-day outcomes between different surgical approaches were compared using univariate and multivariable analysis. Results: During the study period, 1,067 open, 971 laparoscopic, and 341 robotic ileal pouch anal anastomosis were performed. The most frequent indications were inflammatory bowel disease (64%), malignancy (18%), and familial adenomatous polyposis (7%). Mean age of the cohort was 43 ± 15 years with 43% female and 76% with body mass index ≤30 kg/m2. Overall morbidity was 26.8% for the entire cohort with 4% anastomotic leak, 6% reoperation, 21% ileus, and 21% readmission rate. After adjusting for available confounders, operative approach was not associated with better short-term outcomes, including length of stay, overall morbidity, anastomotic leak, reoperation, incidence of ileus, and 30-day readmissions. Conclusion: Ileal pouch anal anastomosis continues to be associated with significant postoperative morbidity regardless of operative approach. Patient-related advantages in terms of perioperative outcomes for laparoscopic and robotic platforms compared to open surgery are less pronounced in complex operations such as ileal pouch anal anastomosis.http://www.sciencedirect.com/science/article/pii/S258984502200032X |
| spellingShingle | Dorcas Opoku Alexander Hart, MPH Dakota T. Thompson, MD Catherine G. Tran, MD Mohammed O. Suraju, MD Jeremy Chang, MD Sonja Boatman, MD Alexander Troester, MD Paolo Goffredo, MD Imran Hassan, MD, FACS, FASCRS Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach? Surgery Open Science |
| title | Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach? |
| title_full | Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach? |
| title_fullStr | Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach? |
| title_full_unstemmed | Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach? |
| title_short | Equivalency of short-term perioperative outcomes after open, laparoscopic, and robotic ileal pouch anal anastomosis. Does procedure complexity override operative approach? |
| title_sort | equivalency of short term perioperative outcomes after open laparoscopic and robotic ileal pouch anal anastomosis does procedure complexity override operative approach |
| url | http://www.sciencedirect.com/science/article/pii/S258984502200032X |
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