Luca Stocchi

Background Robotic surgery is increasingly used to treat ileocolic Crohn’s disease (CD). However, there is scant data on postoperative recurrence following robotic primary ileocolonic resection (RICR) when compared to laparoscopic primary ileocolonic resection (LICR). Methods All consecutive adult patients who underwent RICR or LICR for CD between January 2016 and November 2024 and endoscopic follow-up at our institution were included in this study. The primary outcome was endoscopic recurrence (ER). Secondary outcomes included postoperative morbidity, clinical recurrence (CR), and surgical recurrence (SR). Results A total of 314 patients were included in the study (82 with RICR vs. 232 with LICR). RICR was significantly associated with a higher rate of iso-peristaltic side-to-side anastomoses (68.3% vs. 21.6% in LICR, p < 0.001), while anti-peristaltic side-to-side anastomoses were prevalent in LICR with the same proportion. After a median follow-up of 11.5 (6.6, 28.5) months, 115 of 314 patients developed ER. Both 1-year and 3-year ER-free survival rates were similar (71.8% vs. 73.0% and 51.4% vs. 55.9% for RICR and LICR, respectively; p = 0.82). After a median clinical follow-up of 37.6 (2.2, 111.5) months, no significant differences were observed between RICR and LICR in either cumulative CR (20.7% vs 27.2%, p = 0.3) or SR (3.7% vs. 0.9%, p = 0.11). Robotic iso-peristaltic anastomosis demonstrated similar postoperative morbidity, ER, CR, and SR rates when compared to both laparoscopic anti-peristaltic and iso-peristaltic configurations. Multivariable Cox regression analysis identified conversion to open approach (Hazard Ratio (HR): 1.8, p = 0.03) and lack of postoperative prophylaxis (HR: 0.6, p = 0.01) as independent risk factors associated with ER. Conclusions Robotic ICR for CD is an effective approach with disease recurrence rates comparable to those of laparoscopic surgery in long-term outcomes. The specific anastomotic configuration should be left at the discretion of the operating surgeon.

BACKGROUND: Early recognition of postoperative ileus remains difficult. OBJECTIVE: To determine whether myoelectric activity recorded by a noninvasive, wireless patch system correlated with the onset of postoperative ileus/bowel dysfunction. DESIGN: Single-arm, prospective study. The surgeon was blinded to myoelectric bowel activity until study completion. SETTINGS: Single surgeon, tertiary referral center. PATIENTS: Consecutive adult patients undergoing abdominal colorectal surgery. INTERVENTIONS: Three wireless patches acquiring myoelectrical GI activity were placed on the abdomen after surgery and removed before hospital discharge/reoperation. All patients followed an enterprise-specific enhanced recovery protocol. MAIN OUTCOME MEASURES: Ileus (nausea, vomiting, abdominal distention requiring nasogastric tube placement) or bowel dysfunction (similar symptoms without nasogastric tube needed) detected clinically within 30 postoperative days. Daily gut activity prints (histograms of the frequencies of all peaks detected in 10-minute time windows) were created for each patient for every 4-hour period after surgery, and activity was averaged and plotted for each group. Peaks in the 8 to 12 cycles per minute range were assigned to intestinal activity, and the energy under the peaks was summed through day 1, day 2, and day 3 and compared among patients. RESULTS: Patch application on 46 enrolled cases undergoing abdominal colorectal surgery (open in 17, robotic in 11, laparoscopic in 18) was not associated with any adverse events. Hyperactive intestinal activity was significantly higher in 12 patients who developed postoperative ileus/bowel dysfunction within 16 hours postoperatively ( p = 0.041), with a more pronounced difference at 20 and 24 hours ( p = 0.016 and p = 0.013, respectively). LIMITATIONS: Data were collected blindly during standard postoperative care; therefore, the integration of technology into clinical practice remains to be tested. CONCLUSIONS: Noninvasive measurement of intestinal myoelectrical activity allowed early identification of postoperative ileus/bowel dysfunction. Future studies will assess the possible advantages deriving from the integration of this system into clinical practice. See Video Abstract . LOS PICOS INTESTINALES HIPERACTIVOS OBSERVADOS POCAS HORAS DESPUÉS DE LA CIRUGÍA COLORRECTAL IDENTIFICAN A LOS PACIENTES QUE DESARROLLAN ÍLEO POSOPERATORIO: ANTECEDENTES: El reconocimiento precoz del íleo posoperatorio sigue siendo difícil. OBJETIVO: Determinar si la actividad mioeléctrica registrada por un sistema de parches inalámbricos no invasivos se correlacionaba con la aparición de íleo posoperatorio/disfunción intestinal. DISEÑO: Estudio prospectivo de un solo grupo. El cirujano desconocía la actividad mioeléctrica intestinal hasta la finalización del estudio. ENTORNO: Un solo cirujano, centro de referencia terciario. PACIENTES: Pacientes adultos consecutivos sometidos a cirugía colorrectal abdominal. INTERVENCIONES: Se colocaron tres parches inalámbricos que registraban la actividad mioeléctrica gastrointestinal en el abdomen después de la cirugía y se retiraron antes del alta hospitalaria o la reintervención. Todos los pacientes siguieron un protocolo de recuperación mejorada específico de la empresa. PRINCIPALES MEDIDAS DE RESULTADO: Íleo (náuseas, vómitos, distensión abdominal que requiere la colocación de una sonda nasogástrica) o disfunción intestinal (síntomas similares sin necesidad de sonda nasogástrica) detectados clínicamente en los 30 días posteriores a la operación. Se crearon GutPrints (histogramas de frecuencias de todos los picos detectados en intervalos de 10 minutos) de la actividad intestinal diaria para cada periodo de 4 horas tras la cirugía, se promediaron y se representaron gráficamente para cada uno de los grupos. Los picos en el rango de 8 a 12 cpm (ciclos por minuto) se asignaron a la actividad intestinal y la energía bajo los picos se sumó a lo largo del día 1, el día 2 y el día 3 y se comparó entre los pacientes. RESULTADOS: La aplicación del parche en 46 casos inscritos sometidos a cirugía colorrectal abdominal (abierta en 17, robótica en 11 y laparoscópica en 18) no se asoció con ningún evento adverso. La actividad intestinal hiperactiva fue significativamente mayor en 12 pacientes que desarrollaron íleo postoperatorio/disfunción intestinal en las 16 horas posteriores a la operación ( p = 0,041), con una diferencia más pronunciada a las 20 y 24 horas ( p = 0,016 y p = 0,013, respectivamente). LIMITACIONES: Los datos se recopilaron de forma ciega durante la atención posoperatoria estándar, por lo que aún queda por comprobar la integración de la tecnología en la práctica clínica. CONCLUSIONES: La medición no invasiva de la actividad mioeléctrica intestinal permitió la identificación temprana del íleo/disfunción intestinal posoperatoria. En futuros estudios se evaluarán las posibles ventajas derivadas de la integración de este sistema en la práctica clínica. ( AI-generated translation )

Introduction: Ileal pouch–anal anastomosis (IPAA) is a common surgical procedure for patients with ulcerative colitis or familial adenomatous polyposis. This study compared the outcomes of robotic, laparoscopic, and open IPAA techniques, with a focus on surgical complications and pouch failure rates. Methods: A retrospective study was conducted of patients who underwent IPAA at three Mayo Clinic locations between 2015 and 2020. Data on patient demographics, surgical details, and postoperative outcomes were collected and compared across the three surgical approaches. Pouch failure was defined as the need for pouch excision or a diverting loop ileostomy. Results: In all, 401 patients underwent IPAA with either an open (149, 37.2%), robotic (145, 36.2%), or laparoscopic (107, 26.7%) technique. The overall rate of pouch failure was 6.5% and did not differ significantly between the three surgical approaches. Compared with laparoscopy, robotic IPAA was associated with a lower conversion rate to open surgery (1.4 versus 17.8%; P < 0.0001) and fewer 30-day readmissions (15.9% versus 28.0%; P = 0.02). However, robotic and laparoscopic IPAA approaches had higher rates of venous thromboembolism/pulmonary embolism and readmission than the open approach. Pouchitis was the most common cause of pouch failure across all surgical techniques. Conclusion: Robotic IPAA had lower conversion and reduced 30-day admission rates compared with a laparoscopic approach. However, open surgery had lower rates of 30-day readmission and rates thromboembolism than robotic IPAA. The surgical approach itself does not appear to significantly impact long-term pouch failure rates.

Introduction: The objective of the study was to investigate the characteristics of patients who underwent surgery for dysplasia detected during chromoendoscopy (CE) surveillance for inflammatory bowel disease (IBD) and the incidence of cancer in the surgical specimen. Methods: A retrospective review of medical records of all patients with dysplasia on a background of underlying IBD diagnosed through CE was carried out at a tri-site enterprise tertiary referral center between 2006 and 2019. We aimed to assess the clinical characteristics of patients requiring surgery for dysplasia and the incidence of cancer in the surgical specimen. Results: Out of 219 patients with dysplasia on CE, 35 underwent surgery for dysplasia (16%). Indications for surgery were multifocal disease (n = 6), endoscopically unresectable lesions (n = 13), visible HGD (n = 7) and unifocal invisible LGD (n = 9). Out of 35 patients requiring surgery, 5 were found to have adenocarcinoma, one of whom with stage IIIB disease received postoperative chemotherapy. No patient with a pathologic diagnosis of adenocarcinoma had any evidence of recurrent disease after a mean postoperative follow-up of 32 months. Conclusions: While the incidence of cancer at the time of surgery for IBD-related dysplasia is not negligible, the rate of node-positive disease is low.