Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children
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1 Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Jeremy D. Kauffman MD, Paul D. Danielson MD, Nicole M. Chandler MD Johns Hopkins All Children s Hospital
2 Disclosures The authors have no financial relationships to disclose The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
3 Introduction Most elective colectomies in children are performed open Studies comparing open and laparoscopic pediatric proctocolectomy with ileoanal anastomosis are limited Pediatric laparoscopic proctocolectomy with creation of J-pouch and stapled ileoanal anastomosis. Ashcraft's Pediatric Surgery. Burns, R. Cartland. Published January 1, Pages Figure
4 Purpose Compare thirty-day outcomes of pediatric laparoscopic vs. open total proctocolectomy with ileoanal anastomosis Hypothesis The laparoscopic approach will result in Decreased risk of complications Shorter length of stay
5 Methods Inclusion criteria: ACS NSQIP Pediatric Elective total proctocolectomy with ileoanal anastomosis Primary outcome: Any 30-day complication Secondary outcomes: Postoperative length of stay, other specific complications Subgroup Analysis: Inflammatory bowel disease, familial adenomatous polyposis
6 Demographics Demographics Total (n=305) Open (n=107) Laparoscopic (n=198) P Age (years) 14 (11-16) 14 (9-16) 15 (12-16) Sex (female) 157 (52) 56 (52) 101 (51) Race White 246 (81) 84 (79) 162 (82) Black 33 (11) 10 (9) 23 (12) Other/Unknown 26 (9) 15 (12.2) 13 (6.6) Weight (kg) 49 (33-62) 48 (29-61) 50 (35-64) 0.223
7 Diagnosis Open Laparoscopic P (n=107) (n=198) Diagnosis <0.014 Benign neoplasm of colon and rectum 38 (36) 95 (48) Inflammatory bowel disease 45 (42) 84 (42) Hirschsprung disease 14 (13) 12 (6) Other 10 (9) 7 (4) The distribution of comorbidities was similar between open and laparoscopic groups.
8 Complications 30-Day Complications Open (n=107) Laparoscopic (n=198) P Any complication 25 (23.4) 31 (15.7) Mortality 0 (0) 1 (0.5) Blood transfusion 4 (3.7) 6 (3.0) Pulmonary complication 4 (3.7) 1 (0.5) Venous Thromboembolism 1 (0.9) 3 (1.5) Sepsis 3 (2.8) 7 (3.5) UTI 2 (1.9) 3 (1.5) Surgical Sight Infection (SSI) 12 (11.2) 16 (8.1) Superficial/Deep SSI 11 (10.3) 6 (3.0) Organ space SSI 1 (0.9) 10 (5.1) Odds ratio of superficial/deep SSI in lap group = 0.27 (CI: ; p=.013)
9 Other Clinical Outcomes 30-Day Outcomes Open (n=107) Laparoscopic (n=198) P-value Median operative time (hours) 4.8 ( ) 5.3 ( ) Median post-op LOS (days) 8 (6-9) 6 (4-9) Unplanned Reoperation 14 (13.1) 28 (14.1) Unplanned Readmission 20 (18.7) 36 (18.2) Related to operation 18 (16.8) 28 (14.1) Unrelated to operation 2 (1.9) 8 (4.0) 0.503
10 Subgroup Analysis Among children with IBD (n=129) post-op LOS and risk of SSI were similar between groups Among children with FAP (n=133), post-op LOS and risk of SSI were decreased in the laparoscopic group. Study Limitations Retrospective Study of a multi-institutional database Sample limited to hospitals participating in NSQIP-P
11 Summary and Conclusions Among children in NSQIP Pediatric that underwent total proctocolectomy with ileoanal anastomosis: The laparoscopic approach was associated with: Shorter postoperative length of stay Decreased risk of superficial or deep surgical sight infection These advantages were not apparent in children with IBD
12 References 1. Flores P, Bailez MM, Cuenca E, Fraire C. Comparative analysis between laparoscopic (UCL) and open (UCO) technique for the treatment of ulcerative colitis in pediatric patients. Pediatr Surg Int 2010 Sep;26(9): Konishi T, Ishida H, Ueno H, Kobayashi H, Hinoi T, Inoue Y, Ishida F, Kanemitsu Y, Yamaguchi T, Tomita N, et al. Feasibility of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis and total colectomy with ileorectal anastomosis for familial adenomatous polyposis: Results of a nationwide multicenter study. Int J Clin Oncol 2016 Oct;21(5): Linden BC, Bairdain S, Zurakowski D, Shamberger RC, Lillehei CW. Comparison of laparoscopic-assisted and open total proctocolectomy and ileal pouch anal anastomosis in children and adolescents. J Pediatr Surg 2013 Jul;48(7): Litz CN, Danielson PD, Chandler NM. Early experience with single-incision laparoscopic total abdominal colectomy in children. J Laparoendosc Adv Surg Tech A 2017 May;27(5): Mahida JB, Asti L, Deans KJ, Minneci PC, Nwomeh BC. Laparoscopic bowel resection for pediatric inflammatory bowel disease. J Surg Res 2015 Nov;199(1): Yeo HL, Isaacs AJ, Abelson JS, Milsom JW, Sedrakyan A. Comparison of open, laparoscopic, and robotic colectomies using a large national database: Outcomes and trends related to surgery center volume. Dis Colon Rectum 2016 Jun;59(6):
13 Thank You
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