Laparoscopic total proctocolectomy with ileal J pouch-anal anastomosis

Minimally invasive surgery has developed as one of the most important advances in surgical techniques. The laparoscopic procedure has been successfully used to perform colonic resections. Inflammatory bowel diseases like ulcerative colitis (UC) and familial adenomatous polyposis (FAP) appear as a main indication for total laparoscopic proctocolectomy.

At the Second Department of Surgery of the "Regina Elena" Institute for Cancer Research, 5 non-selected patients were submitted within a 3-year period (1993-1996) to a total laparoscopic proctocolectomy with a restorative ileal J pouch-anal anastomosis. They comprised 3 males suffering from UC and 2 females affected by FAP.

No patients undergoing laparoscopic procedure were converted. The average operative time was 364 min (480 min in the first case, 290 min in the fifth case). There were no intra-operative or post-operative complications (except a mild peritoneal bleeding in the first case, spontaneously stopped). Post-operative pain was mild and no analgesics were required. Late results were excellent, with good bowel function within 1 year after the operation, without dietetic, working and sport restrictions and without sexual disorders, mainly in males.

Laparoscopic total proctocolectomy in the hands of skilled laparoscopic surgeons is a feasible, safe and effective procedure, with early and late results comparable to, and in some aspects better than, those obtained with "open" surgery. Moreover, it does not have the disadvantage of intra-operative fluid loss, prolonged post-operative ileus, pain and, in younger patients, psychological discomfort of the wide scar.