Aesthetic Benefit of Single-port Laparoscopic Ileo-caecal Resection for Crohn's Disease: a Comparative Study

Overview

Journal Tech Coloproctol

Date 2025 Feb 4

PMID 39903360

Authors

A Antier

A Challine

M Collard

L V OConnell

C Debove

N Chafai

J H Lefevre

Y Parc

Affiliations

Soon will be listed here.

Abstract

Background: Single-port laparoscopy has been mainly studied for colonic cancer or cholecystectomy. Little is known about the cosmetic outcome for patients with Crohn's disease who are the best candidates for single-port surgery. This study aimed to assess cosmetic outcomes with single-port laparoscopy (SPL) vs. multiport laparoscopy (MPL) after ileocolic resection for Crohn's disease.

Methods: This was a retrospective case-control study of a consecutive monocentric cohort. The study was conducted at a tertiary colorectal surgery referral centre. All consecutive patients who underwent an ileocolic resection by laparoscopy between 2012 and 2020 were included. The main outcomes measures, body image and cosmesis after surgery, were evaluated with a validated questionnaire. Secondary endpoints were conversion, morbidity, length of hospital stay and incisional hernia.

Results: Two hundred and six patients were included (SPL, n = 65, 32%). Most patients were operated on for stricturing disease (64%). Conversion rate to laparotomy was 0% in the SPL group and 17.7% in the MPL group (p < 0.001). The complication rate was similar in both groups (SPL, 29.2%; MPL, 38.3%; p = 0.21) as was length of stay (5 days [4-7] in both groups). In total 124 (71%) responded to the questionnaire (MPL, n = 74, 67%; SPL, n = 50, 78%; p = 0.11). The SPL group scored better on the cosmesis scale (21.1 vs. 18.4, p < 0.001). In the SPL group, body image scale scores were better for patients with an intraumbilical incision (intraumbilical 5.2 (± 0.6) vs. periumbilical 6.4 (± 2), p = 0.04). After matching, body image scale scores were similar in both groups (SPL, 6; MPL, 6.4; p = 0.24), but cosmesis scale scores remained better in the SPL group (21.1 vs. 19.3, p = 0.03).

Conclusion: Ileocolic resection for Crohn's disease with single-port laparoscopy has better cosmetic outcomes than with the multiport approach. Postoperative complications and long-term incisional hernia rate are similar. Routine use of an intraumbilical incision could improve cosmetics.

References

Guillou P, Quirke P, Thorpe H, Walker J, Jayne D, Smith A . Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005; 365(9472):1718-26. DOI: 10.1016/S0140-6736(05)66545-2. View

Veldkamp R, Kuhry E, Hop W, Jeekel J, Kazemier G, Bonjer H . Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005; 6(7):477-84. DOI: 10.1016/S1470-2045(05)70221-7. View

Lee Y, Kim J, Kim H, Lee S, Kang B, Kim C . Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer: The SIMPLE Multicenter Randomized Clinical Trial. Ann Surg. 2020; 273(2):217-223. DOI: 10.1097/SLA.0000000000003882. View

Maggiori L, Tuech J, Cotte E, Lelong B, Denost Q, Karoui M . Single-incision Laparoscopy Versus Multiport Laparoscopy for Colonic Surgery: A Multicenter, Double-blinded, Randomized Controlled Trial. Ann Surg. 2018; 268(5):740-746. DOI: 10.1097/SLA.0000000000002836. View

Watanabe J, Ota M, Fujii S, Suwa H, Ishibe A, Endo I . Randomized clinical trial of single-incision versus multiport laparoscopic colectomy. Br J Surg. 2016; 103(10):1276-81. DOI: 10.1002/bjs.10212. View

Gionchetti P, Dignass A, Danese S, Magro Dias F, Rogler G, Lakatos P . 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations. J Crohns Colitis. 2016; 11(2):135-149. DOI: 10.1093/ecco-jcc/jjw169. View

Carvello M, de Groof E, de Buck van Overstraeten A, Sacchi M, Wolthuis A, Buskens C . Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi-port laparoscopy. Colorectal Dis. 2017; 20(1):53-58. DOI: 10.1111/codi.13777. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Dunker M, Stiggelbout A, van Hogezand R, Ringers J, Griffioen G, Bemelman W . Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease. Surg Endosc. 1998; 12(11):1334-40. DOI: 10.1007/s004649900851. View

10.

Maartense S, Dunker M, Slors J, Cuesta M, Pierik E, Gouma D . Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial. Ann Surg. 2006; 243(2):143-9. PMC: 1448907. DOI: 10.1097/01.sla.0000197318.37459.ec. View

11.

Milsom J, Hammerhofer K, Bohm B, Marcello P, Elson P, Fazio V . Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn's disease. Dis Colon Rectum. 2002; 44(1):1-8; discussion 8-9. DOI: 10.1007/BF02234810. View

12.

Brouquet A, Maggiori L, Zerbib P, Lefevre J, Denost Q, Germain A . Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease: Results of a Prospective Nationwide Cohort. Ann Surg. 2018; 267(2):221-228. DOI: 10.1097/SLA.0000000000002017. View

13.

Collard M, Anyla M, Lefevre J, Shields C, Laforest A, Gutton C . Patients' refusal as major limitation of early discharge after colorectal resection in an enhanced recovery program. Langenbecks Arch Surg. 2020; 405(3):337-344. DOI: 10.1007/s00423-020-01879-y. View

14.

Bouteloup G, Lefevre J, Challine A, Voron T, OConnell L, Debove C . C-reactive protein values after surgery for inflammatory bowel disease: is it still a good marker for intra-abdominal complication? A retrospective cohort study of 347 procedures : CRP after inflammatory bowel disease surgery. Int J Colorectal Dis. 2022; 37(11):2347-2356. DOI: 10.1007/s00384-022-04259-8. View

15.

Lurje G, Raptis D, Steinemann D, Amygdalos I, Kambakamba P, Petrowsky H . Cosmesis and Body Image in Patients Undergoing Single-port Versus Conventional Laparoscopic Cholecystectomy: A Multicenter Double-blinded Randomized Controlled Trial (SPOCC-trial). Ann Surg. 2015; 262(5):728-34. DOI: 10.1097/SLA.0000000000001474. View

16.

Marks J, Phillips M, Tacchino R, Roberts K, Onders R, DeNoto G . Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport.... J Am Coll Surg. 2013; 216(6):1037-47. DOI: 10.1016/j.jamcollsurg.2013.02.024. View

17.

Haueter R, Schutz T, Raptis D, Clavien P, Zuber M . Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg. 2017; 104(9):1141-1159. DOI: 10.1002/bjs.10574. View

18.

Benlice C, Stocchi L, Costedio M, Gorgun E, Kessler H . Impact of the Specific Extraction-Site Location on the Risk of Incisional Hernia After Laparoscopic Colorectal Resection. Dis Colon Rectum. 2016; 59(8):743-50. DOI: 10.1097/DCR.0000000000000632. View

19.

Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kubota K . Hernia incidence following a randomized clinical trial of single-incision versus multi-port laparoscopic colectomy. Surg Endosc. 2020; 35(6):2465-2472. DOI: 10.1007/s00464-020-07656-8. View

20.

Abd El Aziz M, Abdalla S, Calini G, Saeed H, DAngelo A, Behm K . Robotic Redo Ileocolonic Resection for Crohn's Disease: A Preliminary Report From a Tertiary Care Center. Dis Colon Rectum. 2022; 66(8):1095-1101. DOI: 10.1097/DCR.0000000000002380. View