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Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative
Girolamo Mattioli1, Edoardo Guida, Alessio Pini-Prato
1Pediatric Surgery Department, Giannina Gaslini Children's Hospital, University of Genova, Largo G. Gaslini 5, 16147, Genova, Italy.
Insights
Laparoscopic ileal-J-pouch-anal anastomosis is a safe and effective treatment for children with ulcerative colitis. This technique offers excellent functional results and quality of life, with minimal complications.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Colorectal surgery
Background:
- Sub-total colectomy and restorative proctocolectomy with J-pouch ileo-anorectal anastomosis is the preferred surgical treatment for pediatric ulcerative colitis unresponsive to medical therapy.
- This study focuses on the technical aspects of laparoscopic ileal-J-pouch anorectal anastomosis in children.
Purpose of the Study:
- To present technical considerations for performing laparoscopic ileal-J-pouch anorectal anastomosis in pediatric patients.
- To highlight innovations in the surgical technique to improve outcomes.
Main Methods:
- A retrospective review of pediatric patients with ulcerative colitis who underwent laparoscopic ileal-J-pouch anorectal anastomosis between January 2006 and February 2011.
- Key technical innovations include a total laparoscopic approach, a 3-cm J-pouch, preservation of the anal canal, use of a Multiple Instrument Access Port system, and electrosurgical vessel sealing for proctectomy.
Main Results:
- Seventeen laparoscopic ileo J-pouch low rectal anastomosis procedures were successfully completed by the same surgical team.
- Postoperative complications included bowel obstruction, ileostomy prolapse, and anastomotic stricture (3 total).
- Excellent functional outcomes, no significant perineal excoriation, and high quality of life were reported in all patients.
Conclusions:
- The use of a Multiport Instrument Access Port facilitated instrument manipulation through a single incision.
- The short ileo J-pouch low rectal anastomosis is a safe, feasible, and effective reconstructive method in pediatric surgery.
Background:
Sub-total colectomy and restorative proctocolectomy with j-pouch ileo-anorectal anastomosis is the treatment of choice in children with ulcerative colitis uncontrolled with medical therapy.
Objective:
To present some technical considerations about children undergoing laparoscopic ileal-J-pouch anorectal anastomosis.
Settings And Patients:
All patients with ulcerative colitis undergoing laparoscopic ileal-J-pouch anorectal anastomosis were evaluated from January 2006 to February 2011.
Intervention:
The new technical innovations herein are (1) total laparoscopic approach, (2) a very short 3-cm J-pouch ileal reservoir created outside the stoma incision, (3) preservation of the entire anal canal and the Knight-Griffen double stapled anastomosis, less than 3 cm from the dentate line, (4) use of a Multiple Instrument Access Port system in the stoma skin incision to reduce the number of port site incisions and (5) proctectomy performed using only an electrosurgical vessels sealing device thus avoiding clips to close rectal pedicle.
Results:
Seventeen laparoscopic ileo J-pouch low rectal anastomosis were performed by the same surgical staff. Three complications occurred postoperatively: one bowel obstruction, one ileostomy prolapse, and one anastomotic stricture. Satisfactory functional results were achieved in all, there was no significant perineal excoriation and quality of life was excellent.
Conclusions:
A Multiport Instrument Access Port placed in the stoma site allowed the use of more instruments through a single incision. The very short ileo J-pouch low rectal anastomosis has been shown to be a safe, feasible, and effective reconstructive procedure.
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