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Single port vs multi-port laparoscopic ileocaecal resection for Crohn's disease

Wed, 02/14/2018 - 15:45
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A retrospective study assessing postoperative pain scores and analgesia requirements after single port and multi-port laparoscopic ileocaecal resection (ICR) for Crohn's disease, has reported that the single port procedure is associated with less pain and a reduction in opioid analgesia compared with the standard multi-port ICR procedure. The paper, ‘Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi-port laparoscopy’, was published in Colorectal Disease.

In total, 101 patients underwent single port ICR and 156 patients underwent multi-port ICR at three European tertiary referral centres (Humanitas Clinical and Research Center, Milan, Italy; Academic Medical Center, Amsterdam, The Netherlands; and University Hospital Leuven, Leuven, Belgium). The consecutive single port ICR patients were compared with a historical cohort of patients undergoing multi-port ICR selected from the same three centres.

The primary end-points of the study were postoperative pain scores and analgesia requirements after surgery. In addition, duration of surgery, conversion to open or multi-port laparoscopic surgery, incision site and incision length, type of anastomosis, any associated surgical procedures, stoma creation and number of additional ports, were also recorded.

Outcomes

The outcomes revealed that the duration of surgery was comparable between the two groups (single port 90–173mins (medium 120) vs and multi-port 100–170mins (medium 128), p=0.24). The number of conversions to open surgery was similar (single port 3% vs multi-port 5.8%, p=0.38). There were no conversions from single port to multi-port.

With regard to postoperative pain VAS scores, patients in the single port group reported significantly lower scores on postoperative days one and two vs the multi-port group (p=0.016 and p=0.04, respectively). The researchers also reported a reduction of analgesia administration (morphine, levobupivacaine/sufentanil) in the single port group vs the multi-port group (p=0.007). Analgesia administration was stopped on day two in a significantly higher number of patients in the single port group than the multi-port group (55% vs 39%, p=0.022).

Concerning postoperative complications, there were no significant differences between the two techniques (single port 24% vs multi-port 19%, p=0.38) or in median hospital stay between the groups (six vs seven days; p=0.45).

The authors note that as the single port procedure involves less abdominal trauma, for that reason alone might it lead to less postoperative pain.

“In conclusion, this large study confirms the safety and feasibility of single port ICR and shows short-term postoperative surgical outcomes comparable to multi-port ICR,” the authors write. “Although more challenging, the single port approach could reduce postoperative pain and the need for prolonged postoperative opioids.”

To access this paper, please click here

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