A Propensity Score-Matched Analysis of Single-Port vs. Multi-Port Laparoscopic Total Abdominal Colectomy with End Ileostomy for Medically Refractory Ulcerative Colitis.

BACKGROUND: Medically refractory ulcerative colitis (UC) necessitates surgical intervention, with total abdominal colectomy with end ileostomy being a definitive treatment. The comparison between single-port and multi-port laparoscopic surgery outcomes remains underexplored. OBJECTIVE: To compare the surgical outcomes of single-port versus multi-port laparoscopic surgery in patients undergoing total abdominal colectomy with end ileostomy for medically refractory UC. DESIGN: A retrospective analysis comparing single-port to multi-port surgery in UC patients from 2010 to 2020. Patients were propensity score-matched 3:1 (multi-port to single-port) on baseline characteristics. SETTINGS: Single center academic hospital. MAIN OUTCOME MEASURES: Binary outcomes were compared using a multivariable logistic regression model, and a subset analysis was conducted for postoperative stump leak based on stump implantation during surgery. These metrics were compared between the single-port and multi-port groups to assess the differences in surgical outcomes. RESULTS: The multi-port and single-port groups included 642 and 114 patients, respectively. Matched cohort included 342 multi-ports and 114 single-ports. We observed a statistically significant difference in mean operation time, with the single-port procedure taking 43 minutes less than the multi-port laparoscopy. There were no significant differences between the two groups in postoperative stump leaks, postoperative ileus, stoma site complications, postoperative readmission within 30 days, postoperative reoperation within 30 days, and subsequent IPAA surgery. In the subset analysis, stump implantation was associated with a higher risk of stump leak in the multiport group. The single-port group had a shorter hospital stay. LIMITATIONS: Retrospective nature, being conducted at a single center. CONCLUSION: Single-incision laparoscopic total abdominal colectomy in the treatment of mucosal ulcerative colitis is a safe, effective, and efficient approach. In our cohort, as compared to multi-port approach, single incision laparoscopy has shown shorter operation times and better overall length of stay. Taking into account less invasive approach, decreased abdominal trauma, and faster recovery, single-port surgery is a viable alternative to multi-port surgery. See Video Abstract.

Beyond antivirals: virus-specific T-cell immunotherapy for BK virus haemorrhagic cystitis and JC virus progressive multifocal leukoencephalopathy.

PURPOSE OF REVIEW: The clinical manifestations of the polyomaviruses BK and JC in immunocompromised patients include BK virus (BKV) induced haemorrhagic cystitis and nephropathy, and JC virus (JCV) associated progressive multifocal leukoencephalopathy (PML) and are typically a consequence of impaired adaptive immunity in the host. To date, little clinical success has been achieved with antiviral agents or other drug therapies to treat these conditions. Here we review the methods and outcomes of the most recent clinical studies utilising adoptive immunotherapy with BK and/or JC virus-specific T-cells (VST) as either prophylaxis or treatment alternatives. RECENT FINDINGS: In the last 12-18 months, several clinical trials have been published in the post-haemopoietic stem cell transplant (HSCT) setting showing good clinical success with the use of VST for treatment of BK viremia ± haemorrhagic cystitis. Between 82 and 100% clinical response has been observed in haemorrhagic cystitis using either third-party or donor-derived VST. The therapy was well tolerated with few cases of graft versus host disease in HSCT recipients, but immune mediated renal allograft loss was observed in one renal transplant recipient. Studies using BKV/JCV VST to treat PML are hindered by few patients who are sufficiently stable to receive VST. In a condition that otherwise carries such poor prognosis, VST were associated with clearance of JC virus, clinical and radiological improvement in some patients. Immune reconstitution inflammatory syndrome was a noted adverse event. SUMMARY: Restoration of BK and JC virus immunity using VST immunotherapy has shown good clinical outcomes in BKV associated infections. Further evaluation with the administration of VST earlier in the course of disease is warranted for the treatment of BKV associated nephropathy in renal allograft and in JCV PML. In both indications, larger cohorts and standardisation of dosing and outcome measures would be of benefit.

Delayed healing of rectal mucosa after endoscopic submucosal dissection (ESD) with nintedanib use.

Nintedanib is a novel antifibrotic agent used in the treatment of interstitial lung diseases. It has been associated with delayed wound healing and wound dehiscence in case reports after major surgeries when used perioperatively. This report presents an unprecedented case of a non-healing ulcer following an endorobotic submucosal dissection of a recurrent, adenomatous rectal polyp, likely due to nintedanib use. In this article, key components of the case were described with the aim to highlight a noteworthy differential diagnosis when suspecting recurrent rectal polyps as well as the need for further research on the effects of nintedanib on healing of polypectomy sites postoperatively.