title: Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection.
abstract: 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.
authors.affiliation: Colorectal Section, General Surgery Department, Hospital Alemán, 1640 Pueyrredón Ave., Buenos Aires, C1118AAT, Argentina. nrotholtz@hospitalaleman.com
authors.forename: Nicolás A
authors.initials: NA
authors.lastname: Rotholtz
authors.forename: María L
authors.initials: ML
authors.lastname: Aued
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Lencinas
authors.forename: Gerardo
authors.initials: G
authors.lastname: Zanoni
authors.forename: Mariano
authors.initials: M
authors.lastname: Laporte
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Bun
authors.forename: Luis
authors.initials: L
authors.lastname: Boerr
authors.forename: Norberto A
authors.initials: NA
authors.lastname: Mezzadri
mesh_terms: 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