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Minimally invasive surgery for inflammatory bowel disease: nationwide evaluation of use and outcomes
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Scientific Poster Presentations: 2015 Clinical Congress
delivery (74 vs 47%, p<0.0001) rates significantly decreased after IPAA creation. Primary diagnosis had no impact on conception before or after IPAA creation (p¼0.265). Infertility was higher after IPAA creation (62 vs 37 %, p<0.0001). While conception was similar in patients following either open or laparoscopic IPAA (44 vs 54 %, respectively; p¼ 0.454), time to conceive was significantly shorter after laparoscopic surgery. IPAA related issues were urgency (5 %, 15 %, 30 %), incontinence (5%, 15 %, 21 %), pad usage (5 %, 13 %, 20 %) during first, second and third trimesters respectively. IPAA functions recovered within a mean time of 4 months after delivery. CONCLUSIONS: Laparoscopic and open IPAA comparably affect the ability to conceive. Among pregnant patients, laparoscopic IPAA is associated with a reduced time to conception. Laparoscopic vs open Hartmann’s reversal: a case-matched study Akin Onder, MD, Emre Gorgun, MD, FACS, Meagan M Costedio, MD, FACS, Hermann P Kessler, MD, PhD, FACS, Luca Stocchi, MD, FACS, Feza H Remzi, MD, FACS, FASCRS Cleveland Clinic, Cleveland, OH INTRODUCTION: Hartmann’s procedure remains the mainstay treatment for perforated, sigmoid diverticulitis. Hartmann’s reversal is a clinically demanding and associated a high rate of morbidity 3% 50% and mortality 1- 7.1%. The aim of this study is to compare short-term outcomes of laparoscopic vs open Hartmann’s reversal. METHODS: Patients who underwent Hartmann’s reversal between January 2005 and September 2014 were identified from a prospectively maintained database and matched for age, gender, body mass index and American Society of Anesthesiologists score to open counterparts. RESULTS: Eighteen patients with laparoscopic Hartmann’s reversal were matched to 18 open patients. There were no differences between laparoscopic vs open groups in operating times, (157.752.2 minutes vs 151.549.3 minutes, p¼0.52) or shortterm complication rates (p >0.99). However, the laparoscopic group was associated with significantly lower estimated blood loss (113.9102.5 cc vs 216.7124.9cc, p¼0.005), faster time to return of bowel function (3.240.6 days vs 4.00.65 days, p¼0.005), and shorter hospital stay (5.43.1days vs 8.34.8 days, p¼0.005). No anastomotic leaks or mortality occurred in either group. CONCLUSIONS: Laparoscopic Hartmann’s reversal can safely be performed with better short-term outcomes in carefully selected patients. Minimally invasive surgery for inflammatory bowel disease: nationwide evaluation of use and outcomes Deborah S Keller, MD, Reena N Tahilramani, MD, Nisreen Madhoun, DO, Juan R Flores-Gonzalez, MD, Sergio H Ibarra, MD, Jaideep S Sandhu, MB, BS, Lisa M Haubert, MD, Eric M Haas, MD, FACS, FASCRS
J Am Coll Surg
Colorectal Surgical Associates, University of Texas Medical School at Houston, Houston, TX INTRODUCTION: The benefits of laparoscopic colorectal surgery continue to develop, and the platform is being increasingly used. However, concerns about the learning curve and safety in inflammatory bowel disease (IBD) remain. Our goal was to evaluate the current use and outcomes for laparoscopy in IBD. METHODS: Review of a prospective national inpatient database identified patients undergoing elective abdominal surgery for IBD from 2008-2011. Patients were stratified by laparoscopic (LAP) or open (OPEN) approach. Stoma closures were excluded. Demographic, procedural, and postoperative outcomes were evaluated. The main outcome measures were the total hospital costs, complications, length of stay (LOS), readmission and mortality rates. RESULTS: 1,472 cases were evaluated: 32% LAP and 68% open. Over the study period, LAP use significantly increased each year, with corresponding declines in OPEN (p¼0.05). The distribution of Crohn’s disease (p¼0.92), ulcerative colitis (p¼0.31), and indeterminate colitis (p¼0.43) was similar across cohorts. Most patients had moderate comorbidities (49.89% LAP, 45.25% OPEN), where rates of LAP and OPEN were comparable (p¼0.0962). There were higher LAP rates in patients with lower comorbidities (p<.0001), and higher OPEN rates in patients with higher comorbidities (p<.0001). The conversion rate was 18.90%. LAP patients had significantly shorter LOS (p<.0001) and lower complication (p<.0001), readmission (p¼.0294), and mortality rates (p¼0.0045). LAP also had significantly lower total costs than OPEN (p<.0001). CONCLUSIONS: Despite proven efficacy, laparoscopy remains underutilized in IBD. Our study further illustrated the patient benefits with laparoscopy. In addition, we demonstrate that laparoscopy lowered total costs for IBD surgery. Conversion did not impact patient or financial outcomes. The laparoscopic approach should be expanded to optimize efficiency and quality in IBD patients.
Multispecialty robotic surgery: a team approach Jacquelyn M Charbel, Amir L Bastawrous, MD, MBA Swedish Medical Center, Seattle, WA INTRODUCTION: Compared to other specialties, robotics has been slow to adoption among colorectal surgeons. The learning curve, immaturity of outcome data, and relative lack of availability of the robotic system have been hindrances to its acceptance. However, one rationale rarely sited as a reason to learn robotic surgery is the necessity of multispecialty robotic surgeons. METHODS: We conducted a retrospective review of robotic cases performed by colorectal surgeons at Swedish Medical Centers. We reviewed the indications and incidences around which colorectal surgeons performed robotic procedures jointly with other robotic specialties.
Scientific Poster Presentations: 2015 Clinical Congress
delivery (74 vs 47%, p<0.0001) rates significantly decreased after IPAA creation. Primary diagnosis had no impact on conception before or after IPAA creation (p¼0.265). Infertility was higher after IPAA creation (62 vs 37 %, p<0.0001). While conception was similar in patients following either open or laparoscopic IPAA (44 vs 54 %, respectively; p¼ 0.454), time to conceive was significantly shorter after laparoscopic surgery. IPAA related issues were urgency (5 %, 15 %, 30 %), incontinence (5%, 15 %, 21 %), pad usage (5 %, 13 %, 20 %) during first, second and third trimesters respectively. IPAA functions recovered within a mean time of 4 months after delivery. CONCLUSIONS: Laparoscopic and open IPAA comparably affect the ability to conceive. Among pregnant patients, laparoscopic IPAA is associated with a reduced time to conception. Laparoscopic vs open Hartmann’s reversal: a case-matched study Akin Onder, MD, Emre Gorgun, MD, FACS, Meagan M Costedio, MD, FACS, Hermann P Kessler, MD, PhD, FACS, Luca Stocchi, MD, FACS, Feza H Remzi, MD, FACS, FASCRS Cleveland Clinic, Cleveland, OH INTRODUCTION: Hartmann’s procedure remains the mainstay treatment for perforated, sigmoid diverticulitis. Hartmann’s reversal is a clinically demanding and associated a high rate of morbidity 3% 50% and mortality 1- 7.1%. The aim of this study is to compare short-term outcomes of laparoscopic vs open Hartmann’s reversal. METHODS: Patients who underwent Hartmann’s reversal between January 2005 and September 2014 were identified from a prospectively maintained database and matched for age, gender, body mass index and American Society of Anesthesiologists score to open counterparts. RESULTS: Eighteen patients with laparoscopic Hartmann’s reversal were matched to 18 open patients. There were no differences between laparoscopic vs open groups in operating times, (157.752.2 minutes vs 151.549.3 minutes, p¼0.52) or shortterm complication rates (p >0.99). However, the laparoscopic group was associated with significantly lower estimated blood loss (113.9102.5 cc vs 216.7124.9cc, p¼0.005), faster time to return of bowel function (3.240.6 days vs 4.00.65 days, p¼0.005), and shorter hospital stay (5.43.1days vs 8.34.8 days, p¼0.005). No anastomotic leaks or mortality occurred in either group. CONCLUSIONS: Laparoscopic Hartmann’s reversal can safely be performed with better short-term outcomes in carefully selected patients. Minimally invasive surgery for inflammatory bowel disease: nationwide evaluation of use and outcomes Deborah S Keller, MD, Reena N Tahilramani, MD, Nisreen Madhoun, DO, Juan R Flores-Gonzalez, MD, Sergio H Ibarra, MD, Jaideep S Sandhu, MB, BS, Lisa M Haubert, MD, Eric M Haas, MD, FACS, FASCRS
J Am Coll Surg
Colorectal Surgical Associates, University of Texas Medical School at Houston, Houston, TX INTRODUCTION: The benefits of laparoscopic colorectal surgery continue to develop, and the platform is being increasingly used. However, concerns about the learning curve and safety in inflammatory bowel disease (IBD) remain. Our goal was to evaluate the current use and outcomes for laparoscopy in IBD. METHODS: Review of a prospective national inpatient database identified patients undergoing elective abdominal surgery for IBD from 2008-2011. Patients were stratified by laparoscopic (LAP) or open (OPEN) approach. Stoma closures were excluded. Demographic, procedural, and postoperative outcomes were evaluated. The main outcome measures were the total hospital costs, complications, length of stay (LOS), readmission and mortality rates. RESULTS: 1,472 cases were evaluated: 32% LAP and 68% open. Over the study period, LAP use significantly increased each year, with corresponding declines in OPEN (p¼0.05). The distribution of Crohn’s disease (p¼0.92), ulcerative colitis (p¼0.31), and indeterminate colitis (p¼0.43) was similar across cohorts. Most patients had moderate comorbidities (49.89% LAP, 45.25% OPEN), where rates of LAP and OPEN were comparable (p¼0.0962). There were higher LAP rates in patients with lower comorbidities (p<.0001), and higher OPEN rates in patients with higher comorbidities (p<.0001). The conversion rate was 18.90%. LAP patients had significantly shorter LOS (p<.0001) and lower complication (p<.0001), readmission (p¼.0294), and mortality rates (p¼0.0045). LAP also had significantly lower total costs than OPEN (p<.0001). CONCLUSIONS: Despite proven efficacy, laparoscopy remains underutilized in IBD. Our study further illustrated the patient benefits with laparoscopy. In addition, we demonstrate that laparoscopy lowered total costs for IBD surgery. Conversion did not impact patient or financial outcomes. The laparoscopic approach should be expanded to optimize efficiency and quality in IBD patients.
Multispecialty robotic surgery: a team approach Jacquelyn M Charbel, Amir L Bastawrous, MD, MBA Swedish Medical Center, Seattle, WA INTRODUCTION: Compared to other specialties, robotics has been slow to adoption among colorectal surgeons. The learning curve, immaturity of outcome data, and relative lack of availability of the robotic system have been hindrances to its acceptance. However, one rationale rarely sited as a reason to learn robotic surgery is the necessity of multispecialty robotic surgeons. METHODS: We conducted a retrospective review of robotic cases performed by colorectal surgeons at Swedish Medical Centers. We reviewed the indications and incidences around which colorectal surgeons performed robotic procedures jointly with other robotic specialties.