Antier A, Challine A, Collard M, O'Connell L V, Debove C, Chafai N, Lefevre J H, Parc Y
Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, 184 rue du faubourg Saint-Antoine, 75012, Paris, France.
Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Tech Coloproctol. 2025 Feb 4;29(1):59. doi: 10.1007/s10151-024-03067-2.
Single-port laparoscopy has been mainly studied for colonic cancer or cholecystectomy. Little is known about the cosmetic outcome for patients with Crohn's disease who are the best candidates for single-port surgery. This study aimed to assess cosmetic outcomes with single-port laparoscopy (SPL) vs. multiport laparoscopy (MPL) after ileocolic resection for Crohn's disease.
This was a retrospective case-control study of a consecutive monocentric cohort. The study was conducted at a tertiary colorectal surgery referral centre. All consecutive patients who underwent an ileocolic resection by laparoscopy between 2012 and 2020 were included. The main outcomes measures, body image and cosmesis after surgery, were evaluated with a validated questionnaire. Secondary endpoints were conversion, morbidity, length of hospital stay and incisional hernia.
Two hundred and six patients were included (SPL, n = 65, 32%). Most patients were operated on for stricturing disease (64%). Conversion rate to laparotomy was 0% in the SPL group and 17.7% in the MPL group (p < 0.001). The complication rate was similar in both groups (SPL, 29.2%; MPL, 38.3%; p = 0.21) as was length of stay (5 days [4-7] in both groups). In total 124 (71%) responded to the questionnaire (MPL, n = 74, 67%; SPL, n = 50, 78%; p = 0.11). The SPL group scored better on the cosmesis scale (21.1 vs. 18.4, p < 0.001). In the SPL group, body image scale scores were better for patients with an intraumbilical incision (intraumbilical 5.2 (± 0.6) vs. periumbilical 6.4 (± 2), p = 0.04). After matching, body image scale scores were similar in both groups (SPL, 6; MPL, 6.4; p = 0.24), but cosmesis scale scores remained better in the SPL group (21.1 vs. 19.3, p = 0.03).
Ileocolic resection for Crohn's disease with single-port laparoscopy has better cosmetic outcomes than with the multiport approach. Postoperative complications and long-term incisional hernia rate are similar. Routine use of an intraumbilical incision could improve cosmetics.
单孔腹腔镜手术主要用于结肠癌或胆囊切除术的研究。对于最适合单孔手术的克罗恩病患者的美容效果知之甚少。本研究旨在评估克罗恩病回结肠切除术后单孔腹腔镜手术（SPL）与多孔腹腔镜手术（MPL）的美容效果。
这是一项对连续单中心队列进行的回顾性病例对照研究。该研究在一家三级结直肠外科转诊中心进行。纳入2012年至2020年间所有接受腹腔镜回结肠切除术的连续患者。主要结局指标，即术后身体形象和美容效果，通过一份经过验证的问卷进行评估。次要终点包括中转开腹、发病率、住院时间和切口疝。
共纳入206例患者（SPL组，n = 65，32%）。大多数患者因狭窄性疾病接受手术（64%）。SPL组中转开腹率为0%，MPL组为17.7%（p < 0.001）。两组并发症发生率相似（SPL组为29.2%；MPL组为38.3%；p = 0.21），住院时间也相似（两组均为5天[4 - 7天]）。共有124例（71%）患者回复了问卷（MPL组，n = 74，67%；SPL组，n = 50，78%；p = 0.11）。SPL组在美容量表上得分更高（21.1分对18.4分，p < 0.001）。在SPL组中，脐内切口患者的身体形象量表得分更好（脐内5.2（±0.6）分对脐周6.4（±2）分，p = 0.04）。匹配后，两组身体形象量表得分相似（SPL组为6分；MPL组为6.4分；p = 0.24），但SPL组美容量表得分仍更高（21.1分对19.3分，p = 0.03）。
克罗恩病回结肠切除术中，单孔腹腔镜手术的美容效果优于多孔手术方法。术后并发症和长期切口疝发生率相似。常规采用脐内切口可改善美容效果。
