Laparoscopic Proctocolectomy

  • David A. EtzioniEmail author
  • Tonia M. Young-Fadok


Laparoscopic proctocolectomy is performed approximately 7,000 times per year in the United States, primarily for indications of ulcerative colitis, Crohn’s colitis, and familial adenomatous polyposis. The operation presents challenges, each of which can be overcome with careful preoperative planning and appropriate intraoperative maneuvers. In this chapter we review the decision-making and technical elements that are important to a successful operation.


Ulcerative Colitis Familial Adenomatous Polyposis Handsewn Anastomosis Ileoanal Pouch Permanent Ileostomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 13.1

Cecal mobilization (MPG 10437 kb)

Video 13.2

Ascending colon mobilization (MPG 8330 kb)

Video 13.3

Upper rectal mobilization with identification of the left ureter (MPG 6445 kb)

Video 13.4

Left colon mobilization in a lateral-to-medial and counterclockwise fashion (MPG 6767 kb)

Video 13.5

Splenic flexure mobilization (counterclockwise) (MPG 6041 kb)

Video 13.6

Splenic flexure mobilization (clockwise) (MPG 8963 kb)

Video 13.7

Completions splenic flexure mobilization of the retroperitoneal attachments (MPG 16256 kb)

Video 13.8

Left side of the rectum mobilization (MPG 29725 kb)

Video 13.9

Mobilization of the distal rectum (MPG 6511 kb)

Video 13.10

Confirming proper orientation of the pouch prior to anastomosis (MPG 12645 kb)


  1. 1.
    Ellis MC, Diggs BS, Vetto JT, et al. Trends in the surgical treatment of ulcerative colitis over time: increased mortality and centralization of care. World J Surg. 2011;35(3):671–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Holubar SD, Long KH, Loftus Jr EV, et al. Long-term direct costs before and after proctocolectomy for ulcerative colitis: a population-based study in Olmsted County, Minnesota. Dis Colon Rectum. 2009;52(11):1815–23.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Kopylov U, Ben-Horin S, Zmora O, et al. Anti-tumor necrosis factor and postoperative complications in Crohn’s disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2012;18(12):2404–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Yang Z, Wu Q, Wang F, et al. Meta-analysis: effect of preoperative infliximab use on early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery. Aliment Pharmacol Ther. 2012;36(10):922–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Yang Z, Wu Q, Wu K, et al. Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. Aliment Pharmacol Ther. 2010;31(4):486–92.PubMedCrossRefGoogle Scholar
  6. 6.
    Richard CS, Cohen Z, Stern HS, et al. Outcome of the pelvic pouch procedure in patients with prior perianal disease. Dis Colon Rectum. 1997;40(6):647–52.PubMedCrossRefGoogle Scholar
  7. 7.
    MacRae HM, McLeod RS, Cohen Z, et al. Risk factors for pelvic pouch failure. Dis Colon Rectum. 1997;40(3):257–62.PubMedCrossRefGoogle Scholar
  8. 8.
    McIntyre PB, Pemberton JH, Wolff BG, et al. Indeterminate colitis. Long-term outcome in patients after ileal pouch-anal anastomosis. Dis Colon Rectum. 1995;38(1):51–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Aziz O, Athanasiou T, Fazio VW, et al. Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg. 2006;93(4):407–17.PubMedCrossRefGoogle Scholar
  10. 10.
    Parc Y, Mabrut JY, Shields C. Surgical management of the duodenal manifestations of familial adenomatous polyposis. Br J Surg. 2011;98(4):480–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Reilly WT, Pemberton JH, Wolff BG, et al. Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa. Ann Surg. 1997;225(6):666–76. discussion 676–7.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Hallgren TA, Fasth SB, Oresland TO, et al. Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy. Eur J Surg. 1995;161(12):915–21.PubMedGoogle Scholar
  13. 13.
    Lovegrove RE, Constantinides VA, Heriot AG, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg. 2006;244(1):18–26.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Wasmuth HH, Trano G, Myrvold HE, et al. Adenoma formation and malignancy after restorative proctocolectomy with or without mucosectomy in patients with familial adenomatous polyposis. Dis Colon Rectum. 2013;56(3):288–94.PubMedCrossRefGoogle Scholar
  15. 15.
    von Roon AC, Will OCC, Man RF, et al. Mucosectomy with handsewn anastomosis reduces the risk of adenoma formation in the anorectal segment after restorative proctocolectomy for familial adenomatous polyposis. Ann Surg. 2011;253(2):314–7.CrossRefGoogle Scholar
  16. 16.
    O’Connell PR, Pemberton JH, Weiland LH, et al. Does rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum. 1987;30(1):1–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Laureti S, Ugolini F, D’Errico A, et al. Adenocarcinoma below ileoanal anastomosis for ulcerative colitis: report of a case and review of the literature. Dis Colon Rectum. 2002;45(3):418–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Smith L, Friend WG, Medwell SJ. The superior mesenteric artery. The critical factor in the pouch pull-through procedure. Dis Colon Rectum. 1984;27(11):741–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Baig MK, Weiss EG, Nogueras JJ, et al. Lengthening of small bowel mesentery: stepladder incision technique. Am J Surg. 2006;191(5):715–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Uraiqat AA, Byrne CM, Phillips RK. Gaining length in ileal-anal pouch reconstruction: a review. Colorectal Dis. 2007;9(7):657–61.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Colon and Rectal SurgeryMayo Clinic College of MedicinePhoenixUSA

Personalised recommendations