Alternative specimen extraction techniques after laparoscopic emergency colectomy in inflammatory bowel disease

• Published in: Surgical endoscopy Vol. 26; no. 2; pp. 408 - 412
• Main Authors: Gardenbroek, Tjibbe J., Eshuis, Emma J., van Acker, Gijs J. D., Tanis, Pieter J., Bemelman, Willem A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Adult; Analgesics, Opioid - therapeutic use; Biological and medical sciences; Colectomy - methods; Colonic Pouches; Digestive system. Abdomen; Emergencies; Emergency Treatment - methods; Endoscopy; Female; Gastroenterology; General aspects; Gynecology; Hepatology; Humans; Inflammatory bowel disease; Inflammatory Bowel Diseases - surgery; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Morphine - therapeutic use; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Proctocolectomy, Restorative - methods; Proctology; Prospective Studies; Reoperation; Specimen Handling - methods; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue Adhesions - etiology; Treatment Outcome; Young Adult; Inflammatory bowel disease; Colectomy; Laparoscopy; Extraction; Colitis; Endoscopic surgery; Digestive system; Gut; Inflammatory disease; Medicine; Crohn disease; Treatment; Digestive diseases; Intestinal disease; Colon; Endoscopy; Technique; Ulcerative colitis
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-011-1888-6

Background Omitting the extraction site incision potentially further decreases the abdominal wall trauma in laparoscopic surgery. The purpose of this study was to report the results of alternative specimen extraction techniques after laparoscopic emergency colectomy in patients with inflammatory bowel disease (IBD). Methods Ten consecutive patients with IBD underwent (sub)acute emergency colectomy for refractory disease from October 2009 until December 2010. The specimen was retrieved via the stoma site in three and transrectally in seven patients. Patient data were prospectively collected. In case of later completion proctectomy and pouch procedure, adhesions were systematically scored. Results The extraction techniques were all feasible. Median operative time was 219 (interquartile range (IQR), 197–232) min. The pain scores and morphine requirement in patients decreased quickly after surgery. No infectious complications occurred. In five patients, a completion proctectomy was performed at a median time of 7 (IQR, 3.8–9.3) months after colectomy. All patients showed absence of any adhesions in the pelvis. In two patients, limited adhesions of the cut side of the mesentery were present. Conclusions Specimen extraction via the rectum or stoma site is a safe, alternative way to extract the specimen after laparoscopic colectomy. No infectious complications were observed postoperatively and no pelvic adhesions were found during completion proctectomy.