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Laparoscopic subtotal colectomy with double-end ileosigmoidostomy in right iliac fossa facilitates second-stage surgery in patients with inflammatory bowel disease

  • Diane Mege
  • Alice Frontali
  • Gianluca Pellino
  • Samuel Adegbola
  • Léon Maggiori
  • Janindra Warusavitarne
  • Yves PanisEmail author
Article

Abstract

Background

There is no consensus about the most appropriate management of rectal stump in laparoscopic subtotal colectomy (STC) performed for inflammatory bowel disease (IBD). The objective is to report our experience of laparoscopic STC with double-end ileosigmoidostomy in the right iliac fossa for IBD.

Methods

All patients undergoing laparoscopic STC and double-end ileosigmoidostomy in the right iliac fossa for IBD in 2 European expert centres were included.

Results

From 1999 to 2017, laparoscopic STC and double-end ileosigmoidostomy in right iliac fossa was performed in 213 consecutive patients, including 74 patients in an emergency setting (35%). Conversion to laparotomy was necessary in 9 patients (4%). One patient died postoperatively (0.5%). Postoperative morbidity occurred in 53 patients (25%) after STC, and was major in 18 patients (8%). A second stage was performed in 199 patients (94%), with a mean delay of 4.7 ± 6 months (range 1.4–77). The second stage was an ileorectal anastomosis (n = 50/199; 25%), performed by an elective open incision in the right iliac fossa in 68% of cases; an ileal pouch-anal anastomosis (IPAA) (n = 139; 70%) successfully performed by laparoscopy in 96% of cases; or an abdominoperineal excision with end ileostomy (n = 10; 5%) successfully performed by laparoscopy in 8 cases. After this second stage, postoperative morbidity occurred in 53 patients (27%), and was major in 15 patients (8%). After a mean follow-up of 3.7 ± 3 years (range 0.1–15), stoma rate (end ileostomy and diverting stoma not closed) was 17%, and small bowel obstruction and incisional hernia occurred in 10 (5%) and 25 (12%) patients, respectively.

Conclusions

Laparoscopic STC and double-end ileosigmoidostomy in right iliac fossa is safe, feasible, and facilitates the second stage for intestinal continuity by either elective incision or laparoscopy in 100% of ileorectal anastomoses and by laparoscopy in 96% of IPAA.

Keywords

Laparoscopic subtotal colectomy Inflammatory bowel disease Double-end ileosigmoidostomy Ileal pouch-anal anastomosis Ileorectal anastomosis Abdominoperineal excision 

Notes

Compliance with ethical standards

Disclosure

Diane Mege, Alice Frontali, Gianluca Pellino, Samuel Adegbola, Léon Maggiori, Janindra Warusavitarne and Yves Panis have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Kin C, Kate Bundorf M (2017) As infliximab use for ulcerative colitis has increased, so has the rate of surgical resection. J Gastrointest Surg 21:1159–1165CrossRefPubMedGoogle Scholar
  2. 2.
    Abelson JS, Michelassi F, Mao J, Sedrakyan A, Yeo H (2017) Higher surgical morbidity for ulcerative colitis patients in the era of biologics. Ann Surg 268:311–317Google Scholar
  3. 3.
    Kulaylat AS, Kulaylat AN, Schaefer EW, Tinsley A, Williams E, Koltun W, Hollenbeak CS, Messaris E (2017) Association of preoperative anti-tumor necrosis factor therapy with adverse postoperative outcomes in patients undergoing abdominal surgery for ulcerative colitis. JAMA Surg 152:e171538CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Gu J, Remzi FH, Shen B, Vogel JD, Kiran RP (2013) Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum 56:1243–1252CrossRefPubMedGoogle Scholar
  5. 5.
    Maggiori L, Bretagnol F, Alves A, Panis Y (2010) Laparoscopic subtotal colectomy for acute or severe colitis with double-end ileo-sigmoidostomy in right iliac fossa. Surg Laparosc Endosc Percutan Tech 20:27–29CrossRefPubMedGoogle Scholar
  6. 6.
    Øresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, Marteau P, Zmora O, Kotze PG, Espin-Basany E, Tiret E, Sica G, Panis Y, Faerden AE, Biancone L, Angriman I, Serclova Z, van Overstraeten ADB, Gionchetti P, Stassen L, Warusavitarne J, Adamina M, Dignass A, Eliakim R, Magro F, D’Hoore A, European Crohn’s and Colitis Organisation (ECCO) (2015) European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 9:4–25CrossRefPubMedGoogle Scholar
  7. 7.
    Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141:640–644CrossRefPubMedGoogle Scholar
  8. 8.
    Leo CA, Samaranayake S, Perry-Woodford ZL, Vitone L, Faiz O, Hodgkinson JD, Shaikh I, Warusavitarne J (2016) Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Colorectal Dis 18:1162–1166CrossRefPubMedGoogle Scholar
  9. 9.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457CrossRefGoogle Scholar
  11. 11.
    Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, Lakatos PL, Adamina M, Ardizzone S, Buskens CJ, Sebastian S, Laureti S, Sampietro GM, Vucelic B, van der Woude CJ, Barreiro-de Acosta M, Maaser C, Portela F, Vavricka SR, Gomollón F, ECCO (2017) 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohn’s Colitis 11:135–149CrossRefGoogle Scholar
  12. 12.
    Ouaïssi M, Alves A, Bouhnik Y, Valleur P, Panis Y (2006) Three-step ileal pouch-anal anastomosis under total laparoscopic approach for acute or severe colitis complicating inflammatory bowel disease. J Am Coll Surg 202:637–642CrossRefPubMedGoogle Scholar
  13. 13.
    Tilney HS, Lovegrove RE, Heriot AG, Purkayastha S, Constantinides V, Nicholls RJ, Tekkis PP (2007) Comparison of short-term outcomes of laparoscopic vs. open approaches to ileal pouch surgery. Int J Colorectal Dis 22:531–542CrossRefPubMedGoogle Scholar
  14. 14.
    Fleming FJ, Francone TD, Kim MJ, Gunzler D, Messing S, Monson JRT (2011) A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis. Dis Colon Rectum 54:176–182CrossRefPubMedGoogle Scholar
  15. 15.
    Bartels SL, Gardenbroek TJ, Ubbink DT, Buskens CJ, Tanis PJ, Bemelman WA (2013) Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 100:726–733CrossRefPubMedGoogle Scholar
  16. 16.
    Maggiori L, Khayat A, Treton X, Bouhnik Y, Vicaut E, Panis Y (2014) Laparoscopic Approach for Inflammatory Bowel Disease Is a Real Alternative to Open Surgery. Ann Surg 260:305–310CrossRefPubMedGoogle Scholar
  17. 17.
    Lee EC, Truelove SC (1980) Proctocolectomy for ulcerative colitis. World J Surg 4:195–201CrossRefPubMedGoogle Scholar
  18. 18.
    Ng RL, Davies AH, Grace RH, Mortensen NJ (1992) Subcutaneous rectal stump closure after emergency subtotal colectomy. Br J Surg 79:701–703CrossRefPubMedGoogle Scholar
  19. 19.
    Kyle SM, Steyn RS, Keenan RA (1992) Management of the rectum following colectomy for acute colitis. Aust N Z J Surg 62:196–199CrossRefPubMedGoogle Scholar
  20. 20.
    Wøjdemann M, Wettergren A, Hartvigsen A, Myrhøj T, Svendsen LB, Bülow S (1995) Closure of rectal stump after colectomy for acute colitis. Int J Colorectal Dis 10:197–199CrossRefPubMedGoogle Scholar
  21. 21.
    McKee RF, Keenan RA, Munro A (1995) Colectomy for acute colitis: is it safe to close the rectal stump? Int J Colorectal Dis 10:222–224CrossRefPubMedGoogle Scholar
  22. 22.
    van Overstraeten ADB, Mark-Christensen A, Wasmann KA, Bastiaenen VP, Buskens CJ, Wolthuis AM, Vanbrabant K, D’hoore A, Bemelman WA, Tottrup A, Tanis PJ (2017) Transanal versus transabdominal minimally invasive (completion) proctectomy with ileal pouch-anal anastomosis in ulcerative colitis: a comparative study. Ann Surg 266:878–883CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Colorectal Surgery, Beaujon HospitalAssistance Publique-Hôpitaux de Paris, Université Paris VIIClichyFrance
  2. 2.Department of Colorectal SurgerySt. Mark’s HospitalHarrowUK

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