title: Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative colitis.
abstract: BACKGROUND
  Sub-total colectomy and restorative proctocolectomy with j-pouch ileo-anorectal anastomosis is the treatment of choice in children with ulcerative colitis uncontrolled with medical therapy.
  
  
  OBJECTIVE
  To present some technical considerations about children undergoing laparoscopic ileal-J-pouch anorectal anastomosis.
  
  
  METHODS
  All patients with ulcerative colitis undergoing laparoscopic ileal-J-pouch anorectal anastomosis were evaluated from January 2006 to February 2011.
  
  
  METHODS
  The new technical innovations herein are (1) total laparoscopic approach, (2) a very short 3-cm J-pouch ileal reservoir created outside the stoma incision, (3) preservation of the entire anal canal and the Knight-Griffen double stapled anastomosis, less than 3 cm from the dentate line, (4) use of a Multiple Instrument Access Port system in the stoma skin incision to reduce the number of port site incisions and (5) proctectomy performed using only an electrosurgical vessels sealing device thus avoiding clips to close rectal pedicle.
  
  
  RESULTS
  Seventeen laparoscopic ileo J-pouch low rectal anastomosis were performed by the same surgical staff. Three complications occurred postoperatively: one bowel obstruction, one ileostomy prolapse, and one anastomotic stricture. Satisfactory functional results were achieved in all, there was no significant perineal excoriation and quality of life was excellent.
  
  
  CONCLUSIONS
  A Multiport Instrument Access Port placed in the stoma site allowed the use of more instruments through a single incision. The very short ileo J-pouch low rectal anastomosis has been shown to be a safe, feasible, and effective reconstructive procedure.
authors: Pediatric Surgery Department, Giannina Gaslini Children's Hospital, University of Genova, Largo G. Gaslini 5, 16147, Genova, Italy.
authors: Girolamo
authors: G
authors: Mattioli
authors: Edoardo
authors: E
authors: Guida
authors: Alessio
authors: A
authors: Pini-Prato
authors: Stefano
authors: S
authors: Avanzini
authors: Valentina
authors: V
authors: Rossi
authors: Arrigo
authors: A
authors: Barabino
authors: Arnold G
authors: AG
authors: Coran
authors: Vincenzo
authors: V
authors: Jasonni
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*