title: Laparoscopic restorative proctocolectomy: safety and critical level of the ileal pouch anal anastomosis.
abstract: OBJECTIVE
  The study reports the longer-term results of laparoscopic-assisted restorative proctocolectomy (RPC), with particular reference to safety and the level of the stapled ileal pouch-anal anastomosis (IPAA).
  
  
  METHODS
  Data were collected prospectively from all patients who underwent laparoscopic RP from July 2006 to July 2010. In each patient the operation involved the use of a short (6 cm) Pfannenstiel incision to facilitate placement of the linear stapler for anorectal division.
  
  
  RESULTS
  Seventy-five patients underwent RPC either with total proctocolectomy (n = 53) or after previous emergency colectomy (n = 22). Early postoperative morbidity occurred in 18 (24%) patients and readmission within 30 days occurred in 18 (24%). Morbidity during follow up developed in 29 (39%). A pouchogram was carried out in all 75 patients before ileostomy closure with an abnormality shown in eight. The median level of the IPAA was at 3.0 cm (1.0-5.0 cm) above the dentate line. At a median of 33 (9-57) months, there has been one case of small bowel obstruction and no incisional hernia.
  
  
  CONCLUSIONS
  In laparoscopic-assisted RPC a limited Pfannenstiel incision allows safe construction of the IPAA at an appropriate level. Laparoscopic RPC is safe and the emerging long-term follow-up data show the benefit of this approach, with very low rates of small bowel obstruction and incisional hernia formation.
authors: The John Goligher Department of Colon and Rectal Surgery, The General Infirmary at Leeds, Leeds, LS1 3EX, UK.
authors: S E
authors: SE
authors: Duff
authors: P M
authors: PM
authors: Sagar
authors: M
authors: M
authors: Rao
authors: D
authors: D
authors: Macafee
authors: T
authors: T
authors: El-Khoury
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies; D055815:Young Adult