eP732 - A Propensity Score-Matched Analysis of Single-port vs. Multi-port Laparoscopic Total Abdominal Colectomy with End Ileostomy for Medically Refractory Ulcerative Colitis

ePoster Presenter(s)

• 

  Ali Alipouriani, MD

  Clinical Research Fellow
  Department of colorectal surgery, Cleveland Clinic Foundation
  Department of colorectal surgery, Cleveland Clinic Foundation
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• NY

  Niveditha Yalamathi, MD, MA

  Acting Intern
  Cleveland clinic
  CLEVELAND, Ohio, United States

  Disclosure information not submitted.
• Hs

  Himani sancheti, MS

  Biostatistician
  Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
  CLEVELAND, Ohio, United States

  Disclosure information not submitted.
• BC

  Benjamin Cohen, MD

  Staff
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Stefan D. Holubar, MD, MS

  Director of Research, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Tracy L. Hull, MD

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
  Chagrin Falls, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Scott Steele, MD MBA

  President, Chairman, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• EG

  Emre Gorgun, MD, MBA

  Vice Chair, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Purpose/Background: Background: Laparoscopic surgery has become the preferred approach for total abdominal colectomy and end ileostomy in patients with medically refractory ulcerative colitis (UC). While multi-port laparoscopic techniques are standard, single-port laparoscopy has emerged as a less invasive option. However, data comparing outcomes of single-port versus multi-port laparoscopic total colectomy are limited. The aim of this study was to compare postoperative outcomes between single-port and multi-port laparoscopic total abdominal colectomy with end ileostomy for the treatment of medically refractory UC.Methods/Interventions:

Methods: Patients undergoing single-port vs. multi-port total abdominal colectomy with end ileostomy for medically refractory UC between 2010 and 2020 were propensity score-matched with a 3:1 multi-port to single-port ratio using baseline variables including age, gender, BMI, ASA classification, comorbidities, steroid use, and past abdominal surgeries. Binary outcomes were compared using a multivariable logistic regression model, and a subset analysis was conducted for post-operative stump leak based on stump implantation during surgery. These metrics were compared between the single-port and multi-port groups to assess the differences in surgical outcomes.Results/Outcomes:

Results: The multi-port and single-port groups included 607 and 114 patients, respectively. Matched cohort included 342 multi-ports and 114 single-ports. We observed a statistically significant difference in mean operation time, with the single-port procedure taking 43 minutes (p < 0.001) less than the multi-port laparoscopy. There were no significant differences between the two groups in post-op stump leaks, post-op ileus, stoma site complications, post-op readmission within 30 days, post-op reoperation within 30 days, and subsequent IPAA surgery. In the subset analysis, stump implantation was associated with a higher risk of stump leak (p=0.004) in the multiport group. The single-port group had a shorter hospital stay (6.51 vs 5.34, p=0.077).Conclusion/

Discussion:

Conclusion: Single-incision laparoscopic total abdominal colectomy in the treatment of mucosal ulcerative colitis is a safe, effective and efficient approach. In our cohort, as compared to multi-port approach, single incision laparoscopy has shown shorter operation times and better length of stay. Taking into account less invasive approach, decreased abdominal trauma, and faster recovery, single-port surgery is a viable alternative to multi-port surgery.Table 1. patients' outcome, stump leak subset analysis