Skip to main content
Erschienen in: Surgical Endoscopy 11/2015

01.11.2015

Minimal invasive surgery: NOSE and NOTES in ulcerative colitis

verfasst von: Marta M. Tasende, Salvadora Delgado, Marta Jimenez, Gabriel Diaz del Gobbo, María Fernández-Hevia, Borja DeLacy, Jaume Balust, Antonio M. Lacy

Erschienen in: Surgical Endoscopy | Ausgabe 11/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

In patients with ulcerative colitis (UC), laparoscopic pelvic dissection for IPAA is not always straightforward: often, a hand-assistance incision is used to complete the proctectomy, lengthening operative times. Hybrid NOSE and NOTES are emerging as an alternative approach to conventional laparoscopy. We believe that UC patients could benefit from this new hybrid approach in three ways: by easing the proctectomy as performed down to up, avoiding additional incisions and decreasing surgical times. We present the short-term outcomes of our series.

Methods

All patients with UC who required IPAA were enrolled in a single-arm prospective study (July 2011 to March 2014). A three-step procedure was performed. The first step: laparoscopic colectomy (with transanal removal of the colon) and temporary ileostomy. The second step: “down-to-up” proctectomy (with transanal removal of the rectum) and IPAA with a covering ileostomy. We combined simultaneously transanal and laparoscopic approach. The third step: ileostomy closure. Functional outcomes were assessed 3 months after third step.

Results

Eighteen patients were enrolled. Two patients are waiting to complete the second stage, and 16 underwent all surgical steps. Twelve have been evaluated with functional scores. For the first step, the mean operative time was 162.2 min (SD 40.5) and 170 min (SD 50.1) for the second one. The median hospital stay was 6 days (IQR 5–14.75) for the first step and 5.5 (IQR 5–9.75) for the second one. No major complications occurred. Twenty-four-hour defecation frequency was 5.5 per day (SD 1.7), 0.5 per night. Seventy-five percentage of patients may retain stools for more than 30 min; the mean value of Oresland score was 4.7 and Wexner score 1.4.

Conclusions

This is a safe and feasible technique to treat UC patients with good short-term outcomes. Long-term outcomes and controlled trials are needed.
Literatur
2.
Zurück zum Zitat Dignass A, Lindsay JO, Sturm A et al (2012) Second European evidence-based consensus on the diagnosis and management of ulcerative colitis: current management. J Crohn Colitis 6(10):965–990CrossRef Dignass A, Lindsay JO, Sturm A et al (2012) Second European evidence-based consensus on the diagnosis and management of ulcerative colitis: current management. J Crohn Colitis 6(10):965–990CrossRef
3.
Zurück zum Zitat Dunker MS, Bemelman WA, Slors JFM et al (2001) Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 44:1800–1807CrossRefPubMed Dunker MS, Bemelman WA, Slors JFM et al (2001) Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 44:1800–1807CrossRefPubMed
4.
Zurück zum Zitat Kornbluth A, Sachar DB (2010) Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 105:501–524CrossRefPubMed Kornbluth A, Sachar DB (2010) Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 105:501–524CrossRefPubMed
5.
Zurück zum Zitat Hemandas AK, Jenkins JT (2012) Laparoscopic pouch surgery in ulcerative colitis. Ann Gastroenterol 25(4):309–316PubMedCentralPubMed Hemandas AK, Jenkins JT (2012) Laparoscopic pouch surgery in ulcerative colitis. Ann Gastroenterol 25(4):309–316PubMedCentralPubMed
6.
Zurück zum Zitat Marcello PW, Milsom JW, Wong SK et al (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608CrossRefPubMed Marcello PW, Milsom JW, Wong SK et al (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608CrossRefPubMed
7.
Zurück zum Zitat Ooi B, Quah H, Fu C et al (2009) Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 13:61–64CrossRefPubMed Ooi B, Quah H, Fu C et al (2009) Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 13:61–64CrossRefPubMed
8.
Zurück zum Zitat Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293–296CrossRefPubMed Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293–296CrossRefPubMed
9.
Zurück zum Zitat Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210CrossRefPubMed Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210CrossRefPubMed
10.
Zurück zum Zitat Lacy AM, Saavedra-Perez D, Bravo R et al (2012) Minilaparoscopy-assisted natural orifice total colectomy: technical report of a minilaparoscopy-assisted transrectal resection. Surg Endosc 26(7):2080–2085CrossRefPubMed Lacy AM, Saavedra-Perez D, Bravo R et al (2012) Minilaparoscopy-assisted natural orifice total colectomy: technical report of a minilaparoscopy-assisted transrectal resection. Surg Endosc 26(7):2080–2085CrossRefPubMed
11.
Zurück zum Zitat Lacy AM, Rattner DW, Adelsdorfer C et al (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: ‘‘down-to-up’’ total mesorectal excision (TME)—short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172CrossRefPubMed Lacy AM, Rattner DW, Adelsdorfer C et al (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: ‘‘down-to-up’’ total mesorectal excision (TME)—short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172CrossRefPubMed
12.
Zurück zum Zitat Clavien PA, Barkun J, DeOliveira ML et al (2009) The Clavien-Dindo classification of surgical complications Five-year experience. Ann Surg 250:187–196CrossRefPubMed Clavien PA, Barkun J, DeOliveira ML et al (2009) The Clavien-Dindo classification of surgical complications Five-year experience. Ann Surg 250:187–196CrossRefPubMed
13.
Zurück zum Zitat Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–79CrossRefPubMed Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–79CrossRefPubMed
14.
Zurück zum Zitat Öresland T, Fasth S, Nordgren S et al (1990) Pouch size: the important functional determinant after restorative proctocolectomy. Br J Surg 77:265–269CrossRefPubMed Öresland T, Fasth S, Nordgren S et al (1990) Pouch size: the important functional determinant after restorative proctocolectomy. Br J Surg 77:265–269CrossRefPubMed
15.
Zurück zum Zitat Gu J, Stocchi L, Geisler DP et al (2011) Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy? Surg Endosc 25:3294–3299CrossRefPubMed Gu J, Stocchi L, Geisler DP et al (2011) Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy? Surg Endosc 25:3294–3299CrossRefPubMed
16.
Zurück zum Zitat Larson DW, Cima RR, Dozois EJ et al (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis. A single institutional case-matched experience. Ann Surg 243:667–672PubMedCentralCrossRefPubMed Larson DW, Cima RR, Dozois EJ et al (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis. A single institutional case-matched experience. Ann Surg 243:667–672PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Hicks CW, Hodin RA, Savitt L (2014) Does intramesorectal proctectomy with rectal eversion affect postoperative complications compared to standard total mesorectal excision in patients with ulcerative colitis? J Gastrointest Surg 18:385–390CrossRefPubMed Hicks CW, Hodin RA, Savitt L (2014) Does intramesorectal proctectomy with rectal eversion affect postoperative complications compared to standard total mesorectal excision in patients with ulcerative colitis? J Gastrointest Surg 18:385–390CrossRefPubMed
18.
Zurück zum Zitat Rijcken E, Mennigen R, Senninger N et al (2012) Single-port laparoscopic surgery for inflammatory bowel disease. Minim Invasive Surg 2012:106878PubMedCentralPubMed Rijcken E, Mennigen R, Senninger N et al (2012) Single-port laparoscopic surgery for inflammatory bowel disease. Minim Invasive Surg 2012:106878PubMedCentralPubMed
Metadaten
Titel
Minimal invasive surgery: NOSE and NOTES in ulcerative colitis
verfasst von
Marta M. Tasende
Salvadora Delgado
Marta Jimenez
Gabriel Diaz del Gobbo
María Fernández-Hevia
Borja DeLacy
Jaume Balust
Antonio M. Lacy
Publikationsdatum
01.11.2015
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 11/2015
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4087-z

Weitere Artikel der Ausgabe 11/2015

Surgical Endoscopy 11/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.