Totally Laparoscopic Total Proctocolectomy for Ulcerative Colitis

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Author: Alessandro Fichera
Published:
Specialties: General Surgery
Schools: University of Washington Medical Center
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Basic Info

Contributor: Linda Ferrari

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is today considered the gold standard and, in experienced hands, can now be performed safely for UC with a low postoperative complication rate and a long-term pouch failure rate reported less than 10%6-8.

The introduction of minimally invasive techniques might further decrease postoperative morbidity and improve patients’ satisfaction, with reduced impact on body image and better cosmesis9-11. Unfortunately not every patient is a candidate for a restorative operation and, like in the case of our patient, a total proctocolectomy (TPC) with a permanent Brook ileostomy is performed with a laparoscopic approach.

Laparoscopic TPC offers significant advantages over the open conventional procedure in terms of body image and cosmesis, important factors in the acceptance of surgery in this young patient population, while conflicting results have been reported in terms of postoperative recovery. Faster return of bowel function after laparoscopy and decreased use of narcotics have been reported by some authors, not always translating into shorter hospital stay.

DOI: http://dx.doi.org/10.17797/ukm5thekea

Editor Recruited By: Jeffrey B. Matthews, MD

Advanced

Procedure

Totally Laparoscopic Total Proctocolectomy

Indications

Ulcerative Colitis; Crohn's Disease; FAP

Contraindications

Obesity, Intraabdominal adhesion

Instrumentation

Setup

Preoperative Workup

Colonoscopy

Anatomy and Landmarks

Advantages/Disadvantages

Faster return of bowel function

Complications/Risks

injury to the ureter; bleeding

Disclosure of Conflicts

injury to the ureter; bleeding

Acknowledgements

References

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9.Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 2000; 43: 604-608.
10.Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 2001; 44: 1800-1807.
11.Tan JJ, Tjandra JJ. Laparoscopic surgery for ulcerative colitis - a meta-analysis. Colorectal Dis 2006; 8: 626-636.
12.Holder-Murray J, Zoccali M, Hurst RD, Umanskiy K, Rubin M, Fichera A. Totally laparoscopic total proctocolectomy: a safe alternative to open surgery in inflammatory bowel disease. Inflamm Bowel Dis. 2012 May;18(5):863-8.

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