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Single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy in ulcerative colitis; surgical technique and results of a 7-year experience

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Abstract

Background

Total abdominal colectomy with end ileostomy is the first stage of the three-stage surgical treatment of medically refractory ulcerative colitis. Laparoscopic surgery is a safe approach offering several benefits. Single-incision laparoscopic surgery is an alternative minimally invasive approach providing excellent cosmetic results. Literature on single-incision laparoscopic clockwise continuous total abdominal colectomy in the treatment of ulcerative colitis is limited. Aim of the study is to describe our surgical technique and report the outcomes.

Methods

Medically refractory ulcerative colitis patients who underwent single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy by a single surgeon between January 2013 and December 2020 at our tertiary care center are included. Patient charts were reviewed retrospectively.

Results

52 patients were included in the final analysis. 51.9% patients were male with the median age of 31.5 years and body mass index of 22.2 kg/m2. Median duration of operation was 100 min with estimated blood loss of 50 ml. There were no intraoperative complications, conversions to conventional laparoscopy or open surgery. Postoperative complications were reported in 13 (25%) patients with most common being ileus (17.3%). 3 patients had surgical site infections. 2 patients had postoperative bleeding requiring blood transfusion. 2 patients had reoperation within postoperative 30 days. Median length of hospital stay was 2 days. No mortalities were reported.

Conclusion

Single-incision laparoscopic clockwise continuous approach is safe and effective in ulcerative colitis patients undergoing total abdominal colectomy with end ileostomy. Further prospective randomized studies are warranted.

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Funding

There has been no financial support for this work that could have influenced the outcome of this study.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, Cleveland, OH, 44195, USA

    Emre Gorgun, Elif Ozcimen, Sumeyye Yilmaz & Ilker Ozgur

  2. Department of Quantitative Health Sciences, Cleveland Clinic Main Campus, Cleveland, OH, USA

    Xue Jia

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  1. Emre Gorgun
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  2. Elif Ozcimen
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Correspondence to Emre Gorgun.

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Disclosures

Dr. Emre Gorgun is consultant for Olympus, Boston Scientific and DiLumen. Xue Jia, Drs. Elif Ozcimen, Sumeyye Yilmaz and Ilker Ozgur don’t have any conflicts of interest or financial ties to disclose.

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Gorgun, E., Ozcimen, E., Yilmaz, S. et al. Single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy in ulcerative colitis; surgical technique and results of a 7-year experience. Surg Endosc 37, 4065–4074 (2023). https://doi.org/10.1007/s00464-023-09976-x

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