Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis

Abstract

Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still a topic of improvement. We designed a standardized 10-steps, sequential approach to laparoscopic colectomy, based on the philosophy of the “critical view of safety”, with the aim to improve perioperative outcomes (operative duration, estimated blood loss, complications, readmissions, reoperations, and length of postoperative stay). We performed a retrospective cohort study using data from a prospectively maintained clinical database. We included all the consecutive, unselected patients undergoing laparoscopic subtotal colectomy (SCo) for IBD between 2008 and 2019 in a tertiary IBD Italian Centre. Starting from 2015, we regularly adopted the novel Sequential Approach for a Critical-View Colectomy (SACCo) technique. We included 59 (40.6%) patients treated with different laparoscopic approaches, and 86 patients (59.4%) operated on by the SACCo procedure. The mean operating time was significantly shorter for the SACCo group (144 vs. 224 min; p < 0.0001). The SACCo technique presented a trend to fewer major complications (6.8% vs. 8.3%), less readmissions (2.3% vs. 13.5%; p = 0.01), and shorter postoperative hospital stay (7.2 vs. 8.8 days; p = 0.003). Laparoscopic SACCo-technique is a safe and reproducible surgical approach for acute severe colitis and may improve the outcomes of this demanding procedure.

Características de la enfermedad inflamatoria intestinal con respecto a otros centros nacionales de Colombia

“…En la literatura se reporta que el 20 % de los pacientes con CU, y hasta un 80 % de los pacientes con EC, requieren cirugía en el curso de su enfermedad. En los pacientes con CU, la proctocolectomía es la cirugía de elección con objetivo curativo, mientras que la anastomosis ileoanal más la construcción de una bolsa ileal reemplazó a la ileostomía permanente, lo que ha mejorado la calidad de vida de los pacientes (32,33) .…”

Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease

“…The extended use of laparoscopy in referral centers has not only drastically reduced perioperative complications, length of hospitalization, and incisional hernias, but it left the women’s fertility preserved through a notable reduction in adhesions ( 219 – 222 ). It is worth pointing out that laparoscopy can be used to complete a restorative proctocolectomy even in case of staged procedures, with very low conversion rate ( 220 ).…”

Acute severe ulcerative colitis: How to reduce operating time under 150 min for emergency laparoscopic colectomy – a video vignette

“…Over the years we have developed a standardized technique that allows us to reduce operating time below 150 min [5]: a standardized technique facilitates resection and recognition of anatomical pitfalls and avoids mistakes, favouring an easy and reproducible execution of the main surgical steps.…”