Single incision laparoscopic surgery for ileal J-pouch–anal anastomosis: a 15-year review of the literature

Single-incision laparoscopic surgery (SILS) has emerged as a refinement of minimally invasive techniques, offering potential cosmetic and postoperative recovery benefits. This review aimed to evaluate the current evidence regarding the safety, feasibility, and outcomes of SILS for ileal J-pouch-anal anastomosis (IPAA). A structured literature search was performed in PubMed for studies published between January 2010 and January 2025, focusing on adult and pediatric patients undergoing restorative proctocolectomy with IPAA performed through a single incision. Twenty-two studies were identified, encompassing 182 procedures. The mean operative time ranged from 144-284 min. Reported conversion to multiport laparoscopy or open surgery occurred in 3.9% of cases, while the mean estimated blood loss varied from 27-136 mL. The median length of hospital stay was 4 days in most studies. Major postoperative complications (Clavien-Dindo grade ≥III) occurred in approximately 9% of patients, most commonly small-bowel obstruction or anastomotic leak. Cosmetic satisfaction and postoperative pain scores were generally favorable, although long-term functional outcomes were rarely reported. SILS-IPAA appears feasible and safe in selected patients, particularly when performed by experienced surgeons familiar with conventional laparoscopic restorative proctocolectomy. The current literature is heterogeneous and limited by small sample sizes and overlapping institutional data. Further comparative studies, especially in the context of robotic platforms, are needed to define the role of SILS in modern pouch surgery.