ArticleSurgical endoscopy2017
Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution.
Article in Surgical endoscopy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 26 citations in OpenAlex.
- Transanal minimally invasive proctectomy for ulcerative colitis is beneficial in terms of short-term outcomes and defecation function.Annals of gastroenterological surgery · 2024Article
- Implementation of a robotic surgical practice in inflammatory bowel disease.Journal of robotic surgery · 2024Article
- Ileal Pouch-Anal Anastomosis in the Older Adult: a Review of Postoperative Outcomes and Pouchitis Treatment.Current treatment options in gastroenterology · 2022Article
- Minimally Invasive and Robotic Surgery for Ulcerative Colitis.Clinics in colon and rectal surgery · 2022Review
- Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting.World journal of gastrointestinal endoscopy · 2022Article
- Anastomotic Leak after Ileal Pouch-Anal Anastomosis.Clinics in colon and rectal surgery · 2021Review
- Training for Minimally Invasive Surgery for IBD: A Current Need.Clinics in colon and rectal surgery · 2021Review
- Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis.Revista do Colegio Brasileiro de Cirurgioes · 2021Article
- Delayed Ileal Pouch Anal Anastomosis Has a Lower 30-Day Adverse Event Rate: Analysis From the National Surgical Quality Improvement Program.Inflammatory bowel diseases · 2018Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious work from our institution has characterized the learning curve for open ileal pouch-anal anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA.
methodsPerioperative outcomes of 372 minimally invasive IPAA by 20 surgeons (10 high-volume vs. 10 low-volume surgeons) during 2002-2013, included in a prospectively maintained database, were assessed. Predicted outcome models were constructed using perioperative variables selected by stepwise logistic regression, using Akaike's information criterion. Cumulative sums (CUSUM) of differences between observed and predicted outcomes were graphed over time to identify possible improvement patterns.
resultsInstitutional pelvic sepsis and other pouch morbidity rates (hemorrhage, anastomotic separation, pouch failure, fistula) significantly decreased (18.2 vs. 7.0 %, CUSUM peak after 143 cases, p = 0.001; 18.4 vs. 5.3 %, CUSUM peak after 239 cases, respectively, p < 0.001). Institutional total proctocolectomy mean operative times significantly decreased (307 min vs. 253 min, CUSUM peak after 84 cases, p < 0.001), unlike completion proctectomy (p = 0.093) or conversion rates (10 vs. 5.4 %, p = 0.235). Similar learning curves were identified among high-volume surgeons but not among low-volume surgeons. Learning curves were identified in the two busiest individual surgeons for pelvic sepsis (peaks at 47 and 9 cases, p = 0.045 and p = 0.002) and in one surgeon for operative times (CUSUM peak after 16 and 13 cases for both total proctocolectomy and completion proctectomy (p < 0.001 and p = 0.006) but not for other pouch complications (peak at 49 and 41 cases, p = 0.199 and p = 0.094).
conclusionPouch complications, particularly pelvic sepsis, are the most consistent and relevant learning curve end points in laparoscopic IPAA.
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