Laparoscopic Abdominoperineal Resection and Total Proctocolectomy with End Ileostomy

Abstract

Laparoscopic abdominoperineal resection is a common surgical procedure, usually performed for low rectal tumors, mid-rectal tumors in patients with a weak sphincter mechanism, and for recurrent or residual anal cancer. It is usually performed using three to four ports, following the same principles as open surgery, with an advantage of avoiding a major incision as the specimen is retrieved through the perineum. Surgical pitfalls include those problems seen during open surgery such as ureteric, autonomic nerve and vascular injuries, and in addition injury to the epigastric vessels during port placement. Laparoscopic total proctocolectomy with end ileostomy is generally undertaken for patients with extensive colonic Crohn’s disease involving the rectum with or without perianal disease, for familial adenomatous polyposis or patients with ulcerative colitis who decline or are not candidates for restorative procedures. The procedure is performed with five ports including the camera port. The pitfalls of the technique include those issues seen in the abdominoperineal resection, plus injury to the duodenum and right ureter during right colon mobilization. Postoperative care is similar for both procedures; patients are started on a clear liquid diet on the day of surgery and diet is advanced as tolerated. The bladder catheter is kept in place for about 3 days. Patients can often be discharged home after 4–5 days. In patients with an end ileostomy, care is taken to strictly measure the ileostomy output, and start antidiarrheal medications as needed prior to discharge.