Laparoscopic proctocolectomy with ileal pouch-anal anastomosis.

In recent years laparoscopic proctocolectomy with ileal pouch-anal anastomosis has been used as an alternative to conventional open techniques. However, many published series on proctectomy and ileal pouch-anal anastomosis are based on open experience. This paper presents our experience of laparoscopic proctocolectomy with ileal pouch-anal anastomosis to 23 patients with ulcerative colitis and familial adenomatous polyposis. In operations only sample exteriorization and pouch formation were performed using a small left flank incision of about 4 cm, all other steps were performed entirely laparoscopically. None of the laparoscopic procedures required conversion to an open operation, and there were no intraoperative complications. The median operative time was 315 minutes (240 to 460 min), the average blood loss was 130 mL (70 to 270 mL). Postoperative pain was minimal and no patients required analgesic drugs. Bowel function returned in a median of 2 days (1 to 3 d). Postoperative complications were encountered in 5 patients 22%). No patient required surgical reintervention. The median hospital stay was 9 days (7 to 16 d). In conclusion, laparoscopic proctocolectomy with ileal pouch-anal anastomosis is technically feasible and safe. The technique described in this study provides some potential advantages such as improved cosmetic result and less blood loss. It can be used in patients with familial adenomatous polyposis and ulcerative colitis.