Multimedia article. Laparoscopic restorative proctocolectomy with small McBurney incision for ileal pouch construction without protective ileostomy.
OBJECTIVE
Restorative proctocolectomy is a standard treatment for colorectal diseases over decades. At present, this technique is frequently performed via minimal invasive approach. Most reported techniques of laparoscopic restorative proctocolectomy involved a Pfannenstiel incision for the major part of the operation to be performed openly; a double-stapled pouch anal anastomosis technique and protective ileostomy. This study was designed to demonstrate the modification of this technique.


METHODS
This was a retrospective study of seven patients (4 had ulcerative colitis and 3 had familial adenomatous polyposis) who underwent laparoscopic restorative proctocolectomy at King Chulalongkorn Memorial Hospital between September 2004 and February 2007. The details of the procedure are shown in the video. The techniques involve the following: full mobilization of entire colon and rectum using medial to lateral approach, division of submesenteric arcades for ileal pouch elongation with preservation of three to four inner most arcades of distal ileum segment and preservation of both superior mesenteric and ileocolic trunk, ileal pouch construction via a small (3-4 cm) McBurney incision, transanal mucosectomy with removal of the entire rectum and colon transanally, and handsewn ileal pouch-anal anastomosis. None of the patients underwent protective ileostomy.


RESULTS
Mean surgical time was 360 (270-510) minutes, and median blood loss was 230 (100-400) ml. There were neither conversions nor intraoperative surgical complications. However, one patient developed small-bowel obstruction, which was successfully treated by laparoscopic approach. Anastomotic leakage was not found in this series. All patients have good control of their bowel movement as well as a very good cosmetic result during the follow-up period.


CONCLUSIONS
Laparoscopic restorative proctocolectomy with small McBurney incision for ileal pouch construction, without protective ileostomy, is technically feasible and safe.
Sahakitrungruang
Chucheep
C
Colorectal Division, Department of Surgery, Chulalongkorn University, Bangkok, 10330, Thailand. chucheep@hotmail.com
Pattana-arun
Jirawat
J
Tantiphlachiva
Kasaya
K
Atithansakul
Puttarat
P
Rojanasakul
Arun
A
D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D044684:Colon, Transverse / Q000601:surgery; D039021:Colonic Pouches; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D010537:Peritoneum / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery; D013528:Surgical Staplers