Published in:
01-05-2008
Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection
Published in: Surgical Endoscopy | Issue 5/2008
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Purpose
Although many studies have demonstrated good results using laparoscopic proctocolectomy in patients with ulcerative colitis (UC), most surgical procedures require at least one additional incision larger than 5 cm to complete the surgery. The aim of this study was to evaluate the use of laparoscopic proctocolectomy with ileoanal J pouch, with a complete intracorporeal dissection using a 4–5 cm right lower quadrant (RLQ) incision.
Methods
Data were collected prospectively from all patients with UC that were subjected to a proctocolectomy with ileoanal J pouch between August 2003 and December 2006. The dissection was performed completely by laparoscopy using a medial–lateral approach for the colon and a total mesorectal excision for the rectum. Once the rectum was resected laparoscopically, a 4–5 cm incision in the RLQ was performed to resect the specimen and then an end or a loop ileostomy was implanted at the RLQ wound. The surgery was performed in two (proctocolectomy with ileoanal J pouch and loop ileostomy) or three steps (subtotal colectomy and end ileostomy with sigmoid fistula; proctectomy with ileoanal J pouch; and loop ileostomy).
Results
A total of 47 surgical procedures were performed in 32 patients with a mean age of 34.5 ± 15.7 years, of which 56% were male. The mean body mass index was 21 ± 16 kg/m2; 50% of patients underwent surgery in two steps and the other 50% in three steps. Surgery was converted in five (10.6%) cases due to megacolon in one case, narrow pelvis in two, and difficult rectal dissection in two; the overall morbidity rate was 14.9%. Two patients required reoperation and no mortality was registered. The mean operative time was 248 ± 62 min; proctocolectomy 292 ± 61 min, subtotal colectomy 203 ± 43 min, and proctectomy 248 ± 47 min. The mean hospital stay was 4.8 ± 1.9 days, and the mean interval time to close loop ileostomies was 64 ± 12 days.
Conclusions
A complete laparoscopic proctocolectomy dissection is feasible and safe for surgical treatment of UC.