title: Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled technique.
abstract: OBJECTIVE
  Minimally invasive surgery has proved its efficacy for the surgical treatment of ulcerative colitis (UC). The recent evolution in single port (SP) surgery together with transanal rectal surgery could further facilitate minimally invasive surgery in UC patients. This technical note describes a technical modification for single stapled anastomoses in patients undergoing transanal completion proctectomy and ileal pouch-anal anastomosis (ta-IPAA) for UC.
  
  
  METHODS
  A step-by-step approach of the ta-IPAA in UC is described, including pictures and a video illustration.
  
  
  RESULTS
  We describe a ta-IPAA with SP laparoscopy at the ileostomy site. All patients underwent a total colectomy with end-ileostomy for therapy refractory UC in a first step. Colectomy was done by multiport laparoscopy in six patients, while the ileostomy site was used as single port access in five patients. In all 11 patients the stoma site was used for SP mobilization of the mesenteric root and fashioning of the J-pouch. Completion proctectomy was done using a transanal approach. A single stapled anastomosis was performed in all patients. An 18 French catheter was used to approximate the pouch to the rectal cuff.
  
  
  CONCLUSIONS
  A technical modification of the single stapled anastomosis facilitates the formation of the ta-IPAA, further reducing invasiveness in UC patients.
authors: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors: A
authors: A
authors: de Buck van Overstraeten
authors: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors: A M
authors: AM
authors: Wolthuis
authors: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors: A
authors: A
authors: D'Hoore
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D010865:Pilot Projects; D016737:Proctocolectomy, Restorative / Q000379:methods*; D017792:Surgical Stapling / Q000379:methods; D000067368:Transanal Endoscopic Surgery / Q000379:methods*; D016896:Treatment Outcome
keywords: Ileal pouch-anal anastomosis; TAMIS; restorative proctocolectomy; single port laparoscopy; single stapled anastomosis; transanal IPAA