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Totally Laparoscopic Total Proctocolectomy for Ulcerative Colitis

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

Totally Laparoscopic Total Proctocolectomy
Ulcerative Colitis; Crohn's Disease; FAP
Obesity, Intraabdominal adhesion
N/A
Colonoscopy
N/A
Faster return of bowel function
injury to the ureter; bleeding
injury to the ureter; bleeding
N/A
1.Cima RR, Pemberton JH. Medical and surgical management of chronic ulcerative colitis. Arch Surg 2005; 140: 300-310. 2.Hanauer SB. Medical therapy for ulcerative colitis 2004. Gastroenterology 2004; 126: 1582-1592. 3.Rogler G. Medical management of ulcerative colitis. Dig Dis 2009; 27: 542-549. 4.Cima RR. Timing and indications for colectomy in chronic ulcerative colitis: Surgical consideration. Dig Dis 2010; 28: 501-507. 5.Langholz E, Munkholm P, Davidsen M, Binder V. Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology 1992; 103: 1444-1451. 6.Cohen JL, Strong SA, Hyman NH, Buie WD, Dunn GD, Ko CY, Fleshner PR, Stahl TJ, Kim DG, Bastawrous AL, Perry WB, Cataldo PA, Rafferty JF, Ellis CN, Rakinic J, Gregorcyk S, Shellito PC, Kilkenny JW, Ternent CA, Koltun W, Tjandra JJ, Orsay CP, Whiteford MH, Penzer JR. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 2005; 48: 1997-2009. 7.Becker JM. Surgical therapy for ulcerative colitis and Crohn s disease. Gastroenterol Clin North Am 1999; 28: 371-­390, viii-­ix. 8.Alves A, Panis Y, Bouhnik Y, Maylin V, Lavergne-Slove A, Valleur P. Subtotal colectomy for severe acute colitis: a 20-­year experience of a tertiary care center with an aggressive and early surgical policy. J Am Coll Surg 2003; 197: 379-385. 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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