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Laparoscopic robotic-assisted restorative proctocolectomy and ileal J-pouch-anorectal anastomosis in children

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Abstract

Purpose

Total proctocolectomy with ileal J-pouch-anorectal anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC) in children. Considering the well-known advantages of minimally invasive approach, and its main application for the deep pelvis, robotic surgery may be used in UC reconstructive procedures. The aim of the study is to report our experience with Robotic IPAA in children.

Methods

Single surgeon experience on Robotic IPAA were prospectively included. Data on patient demographics, surgical details, complications, and length of stay (LOS), were collected.

Results

Fifteen patients were included. Median age was 13.2 years, median body weight 45 kg. Median operative time was 240 min. Median LOS was 7 days and mean follow-up time 1 year. No intraoperative complication occurred. Five postoperative complications happened: 3 minors treated conservatively (CD I–II), 2 majors needing reintervention under anesthesia (CD IIIb). No mortality was observed.

Conclusion

Our preliminary experience reveals that Robotic IPAA is a safe and feasible option for the surgical treatment of UC in children. A bigger patient sample and a long-term follow-up are needed to confirm our findings.

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References

  1. Ng KS, Gonsalves SJ, Sagar PM (2019) Ileal-anal pouches: a review of its history, indications, and complications. World J Gastroenterol 25(31):4320–4342. https://doi.org/10.3748/wjg.v25.i31.4320

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mattioli G, Barabino A, Aloi M et al (2015) Paediatric ulcerative colitis surgery: Italian survey. J Crohns Colitis 9(7):558–564

    Article  CAS  Google Scholar 

  3. Mattioli G, Castagnetti M, Gandullia P et al (2005) Stapled restorative proctocolectomy in children with refractory ulcerative colitis. J Pediatr Surg 40(11):1773–1779. https://doi.org/10.1016/j.jpedsurg.2005.07.035

    Article  PubMed  Google Scholar 

  4. Mattioli G, Guida E, Pini-Prato A et al (2012) Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative colitis. Pediatr Surg Int 28(4):351–356

    Article  Google Scholar 

  5. Tilney HS, Constantinides V, Ioannides AS et al (2006) Pouch- anal anastomosis vs straight ileoanal anastomosis in pediatric patients: a meta-analysis. J Pediatr Surg 41(11):1799–1808. https://doi.org/10.1016/j.jpedsurg.2006.06.005

    Article  PubMed  Google Scholar 

  6. Seetharamaiah R, West BT, Ignash SJ et al (2009) Outcomes in pediatric patients undergoing straight vs J pouch ileoanal anastomosis: a multicenter analysis. J Pediatr Surg 44(7):1410–1417. https://doi.org/10.1016/j.jpedsurg.2009.01.006

    Article  PubMed  Google Scholar 

  7. Holder-Murray J, Marsicovetere P, Holubar SD (2015) Minimally invasive surgery for inflammatory bowel disease. Inflamm Bowel Dis 21:1443–1458. https://doi.org/10.1097/mib.0000000000000316

    Article  PubMed  Google Scholar 

  8. Buskens CJ, Sahami S, Tanis PJ et al (2014) The potential benefits and disadvantages of laparoscopic surgery for ulcerative colitis: a review of current evidence. Best Pract Res Clin Gastroenterol 28(1):19–27. https://doi.org/10.1016/j.bpg.2013.11.007

    Article  PubMed  Google Scholar 

  9. Ahmed J, Nasir M, Flashman K et al (2016) Totally robotic rectal resection: an experience of the first 100 consecutive cases. Int J Colorectal Dis 31:869–876. https://doi.org/10.1007/s00384-016-2503-z

    Article  CAS  PubMed  Google Scholar 

  10. Al-Bassam A (2010) Robotic-assisted surgery in children: advantages and limitations. J Robot Surg 4(1):19–22. https://doi.org/10.1007/s11701-010-0181-3

    Article  PubMed  Google Scholar 

  11. Mikhail D, Sarcona J, Mekhail M et al (2020) Urologic robotic surgery. Surg Clin N Am 100(2):361–378. https://doi.org/10.1016/j.suc.2019.12.003

    Article  PubMed  Google Scholar 

  12. Cave J, Clarke S (2018) Paediatric robotic surgery. Ann R Coll Surg Engl 100(Suppl 7):18–21. https://doi.org/10.1308/rcsann.supp2.18

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pedraza R, Patel CB, Ramos-Valadez DI et al (2011) Robotic-assisted laparoscopic surgery for restorative proctocolectomy with ileal J pouch-anal anastomosis. Minim Invasive Ther Allied Technol 20:234–239. https://doi.org/10.3109/13645706.2010.536355

    Article  PubMed  Google Scholar 

  14. Pio L, Mattioli G (2017) Robotic assisted proctectomy and ileal J-pouch anorectal anastomosis. In: Mattioli G, Petralia P (eds) Pediatric robotic surgery technical and management aspects, 1st edn. Springer International Publishing, Berlin, pp 159–163

    Chapter  Google Scholar 

  15. Mattioli G, Pini Prato A, Razore B et al (2017) Da vinci robotic surgery in a pediatric hospital. J Laparoendosc Adv Surg Tech A 27(5):539–545. https://doi.org/10.1089/lap.2016.0390

    Article  PubMed  Google Scholar 

  16. Satava RM (2005) Identification and reduction of surgical error using simulation. Minim Invasive Ther Technol 14:257–261. https://doi.org/10.1080/13645700500274112

    Article  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  18. Arena S, Di Fabrizio D, Impellizzeri P et al (2021) Enhanced recovery after gastrointestinal surgery (ERAS) in pediatric patients: a systematic review and meta-analysis. J Gastrointest Surg. https://doi.org/10.1007/s11605-021-05053-7

    Article  PubMed  Google Scholar 

  19. Hamzaoglu I, Baca B, Esen E et al (2020) Short-term results after totally robotic restorative total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis. Surg Laparosc Endosc Percutaneous Tech 30(1):40–44. https://doi.org/10.1097/sle.0000000000000645

    Article  Google Scholar 

  20. Bambrick M, Fazio VW, Hull TL et al (1996) Sexual function following restorative proctocolectomy in women. Dis Colon Rectum 39:610–614. https://doi.org/10.1007/bf02056936

    Article  CAS  PubMed  Google Scholar 

  21. Yoshida K, Araki T, Uchida K et al (2014) Sexual activity after ileal pouch-anal anastomosis in Japanese patients with ulcerative colitis. Surg Today 44(1):73–79. https://doi.org/10.1007/s00595-013-0505-9

    Article  PubMed  Google Scholar 

  22. Williams J (2012) What we know now: pouch surgery 40 years on. Br J Nurs 21(16):S20–S21. https://doi.org/10.12968/bjon.2012.21.sup16.s20

    Article  PubMed  Google Scholar 

  23. Miller AT, Berian JR, Rubin M et al (2012) Robotic-assisted proctectomy for inflammatory bowel disease: a case-matched comparison of laparoscopic and robotic technique. J Gastrointest Surg 16(3):587–594. https://doi.org/10.1007/s11605-011-1692-6

    Article  PubMed  Google Scholar 

  24. Gorfine SR, Gelernt IM, Bauer JJ et al (1995) Restorative proctocolectomy without diverting ileostomy. Dis Colon Rectum 38(2):188–194. https://doi.org/10.1007/bf02052449

    Article  CAS  PubMed  Google Scholar 

  25. Khan K, Manzoor T, Khan S et al (2021) Is diversion free ileal pouch-anal anastomosis a safe procedure? A meta-analysis of 4973 cases. Int J Colorectal Dis 36(4):657–669. https://doi.org/10.1007/s00384-020-03814-5

    Article  PubMed  Google Scholar 

  26. Kartheuser A, Stangherlin P, Brandt D et al (2006) Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited. Fam Cancer 5(3):241–260. https://doi.org/10.1007/s10689-005-5672-4

    Article  PubMed  Google Scholar 

  27. Aberg H, Pahlman L, Karlbom U (2007) Small-bowel obstruction after restorative proctocolectomy in patients with ulcerative colitis. Int J Colorectal Dis 22(6):637–642. https://doi.org/10.1007/s00384-006-0215-5

    Article  PubMed  Google Scholar 

  28. Indar AA, Efron JE, Young-Fadok TM et al (2009) Laparoscopic ileal pouch- anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc 23(1):174–177. https://doi.org/10.1007/s00464-008-0139-y

    Article  PubMed  Google Scholar 

  29. Razmaria AA, Marchetti PE, Prasad SM et al (2014) Does robot-assisted laparoscopic ileocystoplasty (RALI) reduce peritoneal adhesions compared with open surgery? BJU Int 113(3):468–475. https://doi.org/10.1111/bju.12284

    Article  PubMed  Google Scholar 

  30. Fleming FJ, Francone TD, Kim MJETAL (2011) A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis. Dis Colon Rectum 54(2):176–182. https://doi.org/10.1007/dcr.0b013e3181fb4232

    Article  PubMed  Google Scholar 

  31. Ahmed Ali U, Keus F, Heikens JT et al (2009) Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd006267.pub2

    Article  PubMed  Google Scholar 

  32. Lightner AL, Grass F, McKenna NP et al (2019) Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent. Tech Coloproctol 23(3):259–266. https://doi.org/10.1007/s10151-019-01953-8

    Article  CAS  PubMed  Google Scholar 

  33. Beliard A, Prudhomme M (2010) Ileal reservoir with ileo-anal anastomosis: Long-term complications. J Visc Surg 147:e137–e144. https://doi.org/10.1016/j.jviscsurg.2010.07.001

    Article  CAS  PubMed  Google Scholar 

  34. Gonzalez DO, Nwomeh BC (2017) Complications in children with ulcerative colitis undergoing ileal pouch-anal anastomosis. Semin Pediatr Surg 26(6):384–390. https://doi.org/10.1053/j.sempedsurg.2017.10.008

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, Unit of Pediatric Surgery, University of Messina, Messina, Italy

    C. Romeo, D. Di Fabrizio, P. Impellizzeri, S. Arena & P. Antonuccio

  2. IBD Unit Pediatric Department, University of Messina, Messina, Italy

    V. Dipasquale, S. Costa, S. Pellegrino & C. Romano

  3. Pediatric Surgery Unit, Gaslini Children Hospital and Research Center and University of Genoa (DINOGMI), Genoa, Italy

    F. Palo & G. Mattioli

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  1. C. Romeo
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  2. D. Di Fabrizio
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Romeo, C., Di Fabrizio, D., Impellizzeri, P. et al. Laparoscopic robotic-assisted restorative proctocolectomy and ileal J-pouch-anorectal anastomosis in children. Pediatr Surg Int 38, 59–68 (2022). https://doi.org/10.1007/s00383-021-05017-7

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