Total laparoscopic proctocolectomy with colonic J pouch reconstruction in patients with chronic ulcerative colitis

Quintín H. González; Roberto Castañeda Argáiz; Rabí Rabí Mejía Ovalle; Jesús K. Yamamoto-Furusho; Luis F Uscanga

2009, Number 3

<< Back Next >>

Cir Gen 2009; 31 (3)

Total laparoscopic proctocolectomy with colonic 'J' pouch reconstruction in patients with chronic ulcerative colitis

González QH, Castañeda AR, Mejía OR, Yamamoto- Furusho JK, Uscanga LF

Full text

How to cite this article

Language: Spanish
References: 25
Page: 164-168
PDF size: 42.90 Kb.

ABSTRACT

Objectives: To determine if the laparoscopic approach for total proctocolectomy with an ileal pouch anal anastomosis in patients with chronic idiopathic ulcerative colitis (CIUC) has a lower risk of short term postoperative complications and to evaluate the surgical time. Setting: National institute of Medical Sciences and Nutrition "Salvador Zubirán". Third level health care center. Design: Prospective, observational, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables and central tendency measures. Patients and methods: Fifteen patients with CIUC subjected to total laparoscopic proctocolectomy with ileal-pouch anal anastomosis during the period from June 2005 to March 2008. Studied variables were: age, gender, indication for surgery, immunosupressive therapy, surgical time, blood loss, conversion, complications, re-intervention, re-admittance. Results: Age, 32 years (19-68). Indications for surgery: in 10 (66.6%) failure of medical treatment, 3 (20%) intolerance to medical treatment, and 2 (13.3%) toxic colitis. In 13 patients (86.6%) the procedure was performed in two times and in two patients in three times. All patients were managed with loop ileostomy for protection. In 13 patients (86.6%) ileal pouch-anal anastomosis was performed with double stappling and in two (13.3%) the procedure was performed manually because stapplers failed; this was considered as surgical complication. Surgical time was 180 min (120- 240). Surgical bleeding was 90 ml (10-200). Postoperative ileus occurred in the first surgical time and another occurred when closing a diverting ileostomy, and a pulmonary thromboembolism. Mean time to start oral feeding was of 3 days (2-4). The mean in-hospital stay was of 5 days (3-8). Conclusions: Complications were similar to those reported in other series of the same or larger size. Surgical time was lower than previously reported.

REFERENCES

Martel G, Boushey RP. Laparoscopic colon surgery: past, present and future. Surg Clin North Am 2006; 86: 867-97.
Kozol RA, Hyman N, Strong S, Whelan RL, Cha C. Longo WE. Minimizing risk in colon and rectal surgery. Am J Surg 2007; 194: 576-87.
Noel JK, Fahrbach K, Estok R, Cella C, Frame D, Linz H, et al. Minimally invasive colorectal resection outcomes: short-term comparison with open procedures. J Am Coll Surg 2007; 204: 291-307.
Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 2001; 44: 1800-7.
Gorfine SR, Gelernt IM, Bauer JJ, Harris MT, Kreel I. Restorative proctocolectomy without diverting ileostomy. Dis Colon Rectum 1995; 38: 188-94.
Hasegawa H, Watanabe M, Baba H, Nishibori H, Kitajima M. Laparoscopic restorative proctocolectomy for patients with ulcerative colitis. J Laparoendosc Adv Surg Tech A 2002; 12: 403-6.
Casillas S, Delaney CP. Laparoscopic surgery for inflammatory bowel disease. Dig Surg 2005; 22: 135-42.
Delaney CP, Fazio VW. Crohn’s disease of the small bowel. Surg Clin North Am 2001; 81: 137-58.
Larson D, Dozois E, Piotrowicz K. Laparoscopic assisted vs open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 2005; 48: 1845-50.
Seshadri PA, Poulin EC, Schlachta CM, Caddedu MO, Mammazza J. Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages? Surg Endosc 2001; 15: 837-42.
Gunnarsson U, Karlbom U, Docker M, Raab Y, Påhlman L. Proctocolectomy and pelvic pouch—is a diverting stoma dangerous for the patient? Colorectal Dis 2004; 6:23-7.
Larson DW, Davies MM, Dozois EJ, Cima RR, Piotrowicz K, Anderson K, et al. Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis. Dis Colon Rectum 2008, 51: 392-6.
Takahashi T, Ponce de León S, Cárdenas S, Remes JM, García-Osogobio S, Camilo Barreto J, et al. Quality of life after ileo-anal anastomosis. Rev Invest Clin 2002; 54: 397-402.
Rotholtz NA, Aued ML, Lencinas SM, Zanoni G, Laponte M, Bun N, et al. Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection. Surg Endosc 2008; 22: 1303-8.
Brown SR, Eu KW, Seow-Choen F. Consecutive series of laparoscopic-assisted vs minilaparotomy restorative proctocolectomies. Dis Colon Rectum 2001; 41: 397-400.
Kessler H, Hohenberger W. Multimedia article. Laparoscopic restorative proctocolectomy for ulcerative colitis. Surg Endosc 2006; 20: 166.
Hasegawa S, Nomura A, Kawamura J, Nagayama H, Hata H, Yamaguchi T, et al. Laparoscopic restorative total proctocolectomy with mucosal resection. Dis Colon Rectum 2007; 50: 1152-6.
López-Rosales F, González-Contreras Q, Muro JL, Berber MM, de León HT, Fernández OV, et al. Laparoscopic total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis: initial experience in Mexico. Surg Endosc 2007; 21: 2304-7.
Polle SM, Dunker MS, Slors JE, Sprangers MA, Cuesta MA, Gouma DJ, et al. Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial. Surg Endosc 2007; 21: 1301-7.
Agha A, Moser C, Iesalnieks I, Piso P, Schlitt HJ. Combination of hand-assisted and laparoscopic proctocolectomy (HALP): Technical aspects, learning curve and early postoperative results. Surg Endosc 2008; 22: 1547-52.
González-Contreras Q, Moreno-Berber J, Jonjiguitud-Muro L, Tapia Cid-de León H, Vergara-Fernández O, López-Rosales F, et al. Cien procedimientos colorrectales laparoscópicos asistidos, experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Rev Asoc Mex Cir Endoc 2007; 8: 73-78.
Maartense S, Dunker MS, Slors JF, Cuesta MA, Gouma DJ, van Deventer SJ, et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg 2004; 240: 984-92.
McNevin MS, Bax T, MacFarlane M, Moore M, Nye S, Clyde C, et al. Outcomes of a laparoscopic approach for total abdominal colectomy and proctocolectomy. Am Jou Surg 2006; 191: 673-6.
Wexner SD, Reissman P, Pfeifer J, Bernstein M, Geron N. Laparoscopic colorectal surgery: analysis of 140 cases. Surg Endosc 1996; 10: 133-6.
Rivadeneira DE, Marcello PW, Roberts PL, Rusin LG, Murray JJ, Coller JA, et al. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study. Dis Colon Rectum 2004; 47: 1371-6.