title: Minimally invasive subtotal colectomy and ileal pouch-anal anastomosis for fulminant ulcerative colitis: a reasonable approach?
abstract: OBJECTIVE
  This study was designed to evaluate the safety, feasibility, and short-term outcomes of three-stage minimally invasive surgery for fulminant ulcerative colitis.
  
  
  METHODS
  Using a prospective database, we identified all patients with ulcerative colitis who underwent minimally invasive surgery for both subtotal colectomy and subsequent ileal pouch-anal anastomosis at our institution from 2000 to 2007. Demographics and short-term outcomes were retrospectively evaluated.
  
  
  RESULTS
  During seven years, 50 patients underwent minimally invasive subtotal colectomy for fulminant ulcerative colitis; 50 percent were male, with a median age of 34 years. All patients had refractory colitis: 96 percent were taking steroids, 76 percent were recently hospitalized, 59 percent had >/=5 kg weight loss, 57 percent had anemia that required transfusions, 30 percent were on biologic-based therapy, and 96 percent had >/=1 severe Truelove & Witts' criteria. Of these 50 procedures, 72 percent were performed by using laparoscopic-assisted and 28 percent with hand-assisted techniques. The conversion rate was 6 percent. Subsequently, minimally invasive completion proctectomy with ileal pouch-anal anastomosis was performed in 42 patients with a 2.3 percent conversion rate. Median length of stay after each procedure was four days. There was one anastomotic leak and no mortality.
  
  
  CONCLUSIONS
  A staged, minimally invasive approach for patients with fulminant ulcerative colitis is technically feasible, safe, and reasonable operative strategy, which yields short postoperative length of stay.
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: Jirawat
authors.initials: J
authors.lastname: Pattana-Arun
authors.forename: John H
authors.initials: JH
authors.lastname: Pemberton
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
mesh_terms: D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative