Minimally invasive straight laparoscopic total proctocolectomy for ulcerative colitis

Abstract

Introduction:We have performed straight laparoscopic total proctocolectomy for ulcerative colitis, in which all procedures, including transection of the rectum and anastomosis, were performed in the abdominal cavity. The primary objective of this study was to evaluate whether straight laparoscopic total proctocolectomy is technically feasible and safe. Methods: A retrospective database identified 22 consecutive patients who underwent straight laparoscopic total proctocolectomy for ulcerative colitis between March 1998 and September 2007. Patients were excluded if they required emergency surgery. First, to create a stoma site, a minilaparotomy to insert a 15 mm trocar was performed. Seven other trocars, 5 mm in diameter, were then inserted. Mobilization and dissection of the colorectum and anastmosis were performed completely intracorporeally under laparoscopic guidance. Anastomosis of an ileal J-pouch to the anal canal was performed using the double-stapling technique. Results: Nineteen patients were underwent ileal pouch anal canal anastomosis; two underwent ileorectal anastomosis; and one underwent abdominoperineal resection. The median operation time was 355 min (range 255-605); the median blood loss was 50 g (range 0-800); and the median postoperative hospital stay was 24.5 d. Postoperative complications occurred in eight patients, including three (13.6%) with bowel obstruction, two (9.1%) with portal vein thrombosis, one (4.5%) with anastomotic leakage, and one (4.5%) with postoperative hemorrhage. The morbidity rate was 36.4%. There were no intraoperative complications or conversions to conventional surgery. Conclusion: In the context of this study, we have shown that straight laparoscopic total proctocolectomy is technically feasible and safe in patients with ulcerative colitis. APR, abdominoperineal resection; IPAA, ileal pouch-anal canal anastomosis; IRA, ileo-rectal anastomosis; LTC, laparoscopic total colectomy; LTP, laparoscopic total proctocolectomy. H Ozawa et al. Laparoscopic total proctocolectomy for ulcerative colitis Asian J Endosc Surg 3 (2010) 24-27 r 2009 Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd H Ozawa et al. Laparoscopic total proctocolectomy for ulcerative colitis Asian J Endosc Surg 3 (2010) 24-27 r