Vascular High Ligation and Embryological Dissection in Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis.
BACKGROUND
After its description in 1980, restorative proctocolectomy has become the procedure of choice for ulcerative colitis (UC). The supposed advantages of the laparoscopy have proven beneficial for colorectal operations but a standard technique in laparoscopic restorative proctocolectomy (LRP) is still lacking. In this study, we present our technique of LRP with vascular high ligation (VHL) and embryological dissection (ED).


METHODS
This retrospective study reviewed patients who underwent LRP with VHL for UC from January 2009 to June 2015. Of these, only two-stage LRP patients were included to the study. The LRP technique was performed by five ports through a medial-to-lateral approach. The dissection was carried out between the embryological planes and all the vessel roots were highly divided. A diverting ileostomy was performed in all of the patients.


RESULTS
Forty-six patients were operated for UC with the laparoscopic approach. Among these patients, there were 19 (8 females) patients who were performed LRP with VHL. The median age was 42 (range 25-62) years. No intraoperative complications occurred. There was no conversion to open procedure. Early postoperative complications were observed in 3 (15.8%) patients, including postoperative mechanical bowel obstruction (n = 1), wound infection (n = 1), and ileal pouch bleeding (n = 1).


CONCLUSIONS
High ligation of the vessels is not routinely performed except in the presence of malignancy. In our study, we focus on the importance of high ligation and ED for better observation and preservation of the important anatomical structures. According to our opinion, this approach aids in the preservation of the ureters, nerves, and the duodenum providing better observation of dissection planes.
1 Department of General Surgery, Atakent Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Deniz
D
Atasoy
1 Department of General Surgery, Atakent Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Afag
A
Aghayeva
1 Department of General Surgery, Atakent Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Onur
O
Bayraktar
1 Department of General Surgery, Atakent Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Volkan
V
Ozben
1 Department of General Surgery, Atakent Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Bilgi
B
Baca
2 Department of General Surgery, Maslak Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Ismail
I
Hamzaoglu
2 Department of General Surgery, Maslak Hospital, Acibadem University School of Medicine , Istanbul, Turkey .
Tayfun
T
Karahasanoglu
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007415:Intestinal Obstruction / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
embryological dissection; high ligation; laparoscopy; restorative proctocolectomy; ulcerative colitis