Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection.
OBJECTIVE
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/m(2); 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.
Rotholtz
Nicolás A
NA
Colorectal Section, General Surgery Department, Hospital Alemán, 1640 Pueyrredón Ave., Buenos Aires, C1118AAT, Argentina. nrotholtz@hospitalaleman.com
Aued
María L
ML
Lencinas
Sandra M
SM
Zanoni
Gerardo
G
Laporte
Mariano
M
Bun
Maximiliano
M
Boerr
Luis
L
Mezzadri
Norberto A
NA
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult