Alternative specimen extraction techniques after laparoscopic emergency colectomy in
Inflammatory Bowel Disease
Gardenbroek TJ1,2, MD; Eshuis EJ1,2, M.Sc.; van Acker GJD3, MD, PhD; Tanis PJ1, MD,
PhD; Bemelman WA1, MD, PhD
1
Department of Surgery, Academic Medical Center, Amsterdam
2
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam
3
Department of Surgery, Medical Center Haaglanden, The Hague
Omitting the extraction site incision potentially further decreases the abdominal wall trauma
in laparoscopic surgery. The aim of this study was to report the results of alternative specimen
extraction techniques after laparoscopic emergency colectomy in patients with Inflammatory
Bowel Disease (IBD).
Ten consecutive patients with IBD underwent (sub) acute emergency colectomy for refractory
disease from October 2009 until December 2010. Specimen retrieval was done via the stoma
site in three and transrectally in seven patients. Patient data were prospectively collected. In
case of later completion proctectomy and pouch procedure, adhesions were systematically
scored.
In 4 patients the indication for a colectomy was therapy resistant ulcerative colitis, 3 patients
had therapy resistant Crohn’s disease, and 3 patients had undefined colitis of which one
patient developed a toxic colitis. The alternative extraction of the colon specimen was feasible
in all patients. Median operative time was 219 minutes (interquartile range (iqr) 197-232).
The pain scores and morphine requirement in patients decreased quickly after surgery (visual
analogue scale (VAS) pain score of 4.5 on postoperative days 1 and 2 and VAS score 3 on
day 3, and morphine requirement of 60 mg to 49 mg and 0 mg on days 1, 2 and 3 after the
operation, respectively). No infectious complications occurred. In 5 patients a completion
proctectomy was done at a median time of 7 months (iqr 3.8-9.3) after colectomy. All patients
showed absence of any adhesions in the pelvis. In 2 patients limited adhesions of the cut side
of the mesentery was present.
This study suggests that the transrectal and trans-stomal extraction techniques are feasible for
retrieval of the colectomy specimen after laparoscopic subtotal colectomy with low
postoperative morbidity and few intra-abdominal adhesions. The techniques seem to have the
benefits of little postoperative pain, improved cosmesis, and a short recovery period. The
foresights for these alternative extraction techniques are promising; however the techniques
still need refinement and are only applicable in selected patients.