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BackgroundSingle Incision Laparoscopic Surgery (SILS) is attractive because it uses 1 umbilical incision for preparation and extraction of the specimen. However, the procedure is technically demanding compared to conventional laparoscopy, and it is unclear if it is possible to adopt this procedure in an isolated community like Bermuda with a small hospital.MethodsSince the introduction of SILS in Bermuda by an experienced SILS surgeon, 230 patients who underwent SILS colon procedures from 2012-2018 were reviewed. The data were analyzed according to intra- and postoperative events and outcomes. The results were compared to internationally published data.ResultsThere was a low operative time of 127.8 (40-305) minutes. There were only 4 conversions to open surgery (1.7%). The overall complication rate was 11.7% (27 patients). There were 2 postoperative deaths (0.9%). These data are within the range of internationally published data. ConclusionInitiated and guided by an experienced SILS surgeon, the adoption of single-port colon surgery in Bermuda was successful, and the SILS procedure now belongs to the standard procedures for colonic operations in Bermuda.

A 62 year-old patient with therapy-refractory pouchitis after proctocolectomy for ulcerative colitis was admitted with hematochezia and abdominal discomfort. A malignant melanoma (MM) was found after repeated biopsies of the pouch. Complete staging revealed no evidence for distant metastases and the patient underwent abdominoperineal pouch resection. Six weeks later, the patient was readmitted because of severe general deterioration and diffuse metastatic spread to the liver was found. The patient died of hepatorenal syndrome shortly thereafter. Patients with inflammatory bowel disease are at increased risk of developing cancer, including rarities such as MM. Our experience stresses the importance of repeated biopsies in therapy-refractory pouchitis.