Laparoscopic subtotal colectomy for acute or severe colitis with double-end ileo-sigmoidostomy in right iliac fossa

The aim of this study was to report an original technique of laparoscopic subtotal colectomy (STC) for acute colitis complicating inflammatory bowel disease where both ileostomy and sigmoidostomy are located in the right iliac fossa. Thirty-five consecutive laparoscopic STC cases with ileo-sigmoidostomy in right iliac fossa were retrospectively reviewed. There was no mortality. No patient was reoperated until stoma closure. Bowel continuity was restored by either ileorectal anastomosis (n=14) or secondary proctectomy with ileal-pouch-anal anastomosis (IPAA; n=21). Elective approach was performed in 11 of 14 ileorectal anastomoses (79%) and through iterative laparoscopy in 21 of 21 IPAA (100%). Laparoscopic STC with ileo-sigmoidostomy in right iliac fossa avoid a secondary wound incision for sigmoidostomy, and offers the possibility of an elective approach for ileorectal anastomosis as in 79% of the patients. It allowed, in all cases, a totally laparoscopic approach for the second step of IPAA.