Abstract
Background
Since the introduction of laparoscopic colectomy in 1991, experience in laparoscopic bowel surgery has gradually increased. Several reports from specialized centers have demonstrated that laparoscopic colorectal resections are feasible and safe, providing an acceptable alternative to laparotomy for a variety of diseases. Some studies have shown the feasibility, safety, and good functional outcome of the minimally invasive procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). No known studies have investigated laparoscopic proctocolectomy in México. This report aims to describe the first laparoscopic proctocolectomies with ileal pouch anal anastomosis (IPAA) performed at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán (INCMNSZ).
Methods
All the patients in the authors’ institution who underwent a one- or two-stage laparoscopic total proctocolectomy with IPAA between June 2005 and December 2006 were included in the study. All the operations were performed by the same surgeon, who had already completed the learning curve for colorectal laparoscopic procedures.
Results
For the study, 10 patients underwent a laparoscopic proctocolectomy with IPAA by a single surgeon. Eight of the patients underwent a one-stage procedure, whereas two patients with severe colitis underwent a two-step procedure. All the cases were managed with a diverting loop ileostomy. Six patients underwent a standard double-stapled IPAA anastomosis, and two patients with FAP underwent a mucosectomy with a manual IPAA anastomosis. The mean operative time was 187 min, and the mean blood loss was 46 ml. There were two postoperative complications. One patient presented with an early small bowel obstruction due to an internal hernia, which required reoperation. The other complication was a wound infection. The mean return to oral intake was 1.5 days, and the mean length of hospital stay was 3.4 days.
Conclusion
Although this was not a comparative study and although sample size imposed limitations, with this preliminary data, we conclude that the laparoscopic approach to UC and FAP at our institution is safe, feasible, and effective. However, to achieve the benefits in postoperative outcome, this procedure should be performed only by experienced laparoscopic surgeons.
Similar content being viewed by others
References
Maartense S, Dunker M, Slors J, Cuesta MA, Gouma DJ, van Deventer SJ, van Bodegraven AA, Bemelman WA (2004) Hand-assisted laparoscopic versus open restorative proctolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg 240:948–992
Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK (1995) Ileal pouch anal anastomosis complications and function in 1,005 patients. Ann Surg 222:120–127
Delgado Plasencia L, Arteaga González I, López-Tomassetti Fernández EM, Martín Malagón A, Díaz Luis H, Carrillo Pallarés A (2006) Restorative proctocolectomy with an ileoanal pouch: the role of laparoscopy. Rev Esp Enferm Dig 98:420–428
Kienle P, Z'graggen K, Schmidt J, Benner A, Weitz J, Büchler MW (2005) Laparoscopic restorative proctocolectomy. Br J Surg 92:88–93
Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608
Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ (2001) Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional assisted restorative proctocolectomy: a comparative study. Dis Colon Rectum 44:1800–1807
Sardinha T, Wexner S (1998) Laparoscopy for inflammatory bowel disease: pros and cons. World J Surg 22:370–374
Antolovic D, Kienle P, Knaebel HP, Schmidt J, Gutt CN, Weitz J, Koch M, Büchler MW, Seiler CM (2006) Totally laparoscopic versus conventional ileoanal pouch procedure: design of a single-centre expertise-based randomized controlled trial to compare the laparoscopic and conventional surgical approach in patients undergoing primary elective restorative proctocolectomy: LapConPouch trial. BMC Surg 6:13
Tan J, Tjandra J (2006) Laparoscopic surgery for ulcerative colitis: a meta-analysis. Colorectal Dis 8:626–636
Wexner S, Cera S (2005) Laparoscopic surgery for ulcerative colitis. Surg Clin North Am 85:35–47
McNevin MS, Bax T, MacFarlane M, Moore M, Nye S, Clyde C, Lin P, Beyersdorf S, Ahmad R, Bates D (2006) Outcomes of a laparoscopic approach for total abdominal colectomy and proctocolectomy. Am J Surg 191:673–676
Larson DW, Dozois EJ, Piotrowicz K, Cima RR, Wolff BG, Young-Fadok TM (2005) Laparoscopic-assisted vs open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 48:1845–1850
Milsom JW, Ludwig KA, Church JM, Garcia-Ruiz A (1997) Laparoscopic total abdominal colectomy with ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 40:675–678
Ky A, Sonoda T, Milsom J (2002) One-stage laparoscopic restorative proctocolectomy: an alternative to the conventional approach? Dis Colon Rectum 45:207–211
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
López-Rosales, F., González-Contreras, Q., Muro, L.J. et al. Laparoscopic total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis: initial experience in Mexico. Surg Endosc 21, 2304–2307 (2007). https://doi.org/10.1007/s00464-007-9523-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9523-2