Total Colectomy and Proctocolectomy: Laparoscopic Approach

Abstract

“Fast-track” or “enhanced recovery” programs have become paramount in the treatment and care of patients undergoing colorectal surgery. This strategy is divided in three important elements: preoperative, intraoperative, and postoperative care. Of these, the use of laparoscopy has become essential in the reduction of postoperative physiologic stress, morbidity, and reduced hospital length of stay. Surgery remains the only definite treatment in our armamentarium against ulcerative colitis (UC) and laparoscopic restorative proctocolectomy with ileoanal pouch anastomosis (RPC-IPAA) its most attractive alternative. Total colectomy with ileorectal anastomosis also referred to as subtotal colectomy with primary anastomosis may be performed on patients with the attenuated form of familial adenomatous polyposis (FAP) or MUTYH-associated polyposis (MAP) and patients with colon cancer associated with hereditary nonpolyposis colorectal cancer (HNPCC), synchronous colon cancer, or an obstructing mass causing severe dilation of the proximal colon. Other cases include colonic inertia as well as lower gastrointestinal (LGI) bleeding. This chapter will focus on the aforementioned procedures and will review some of the literature supporting their use.