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Laparoscopic restorative proctocolectomy ileal pouch anal anastomosis: How I do it?

Madnani MA, Mistry JH, Soni HN, Shah AJ, Patel KS, Haribhakti SP - J Minim Access Surg (2015 Jul-Sep)

Bottom Line: Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients.Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery.So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, Sterling Hospital, Ahmedabad, Gujarat, India.

ABSTRACT
Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA).

No MeSH data available.


Related in: MedlinePlus

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Figure 2: Showing port placement

Mentions: Patient is positioned in Trendelenberg with low lithotomy, both arms by side of patient and tucked in. Popliteal fossae are protected with adequate padding [Figure 1]. Extensions are used for IV lines. Two monitors are required on both sides of patient. Urinary bladder is catheterized with adequate size of Foley's catheter. After induction of anaesthesia parts are prepared. Pneumoperitoneum is created with Veress needle and metalic flap port of 10mm size is inserted through infraumbilical midline vertical incision. 12mm working port in right iliac fossa (RIF) is placed just lateral to mid-clavicular line and below level of McBurney's point. Five mm ports are inserted in right upper quadrant (RUQ) and left upper quadrant (LUQ) at mid clavicular line and in left iliac fossa (LIF) at mid-clavicular line at point corresponding to McBurney's point on right side [Figure 2]. Pressure of pneumoperitoneum is set at 12mm of Hg and flow at ten L/min.


Laparoscopic restorative proctocolectomy ileal pouch anal anastomosis: How I do it?

Madnani MA, Mistry JH, Soni HN, Shah AJ, Patel KS, Haribhakti SP - J Minim Access Surg (2015 Jul-Sep)

Showing port placement
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499933&req=5

Figure 2: Showing port placement
Mentions: Patient is positioned in Trendelenberg with low lithotomy, both arms by side of patient and tucked in. Popliteal fossae are protected with adequate padding [Figure 1]. Extensions are used for IV lines. Two monitors are required on both sides of patient. Urinary bladder is catheterized with adequate size of Foley's catheter. After induction of anaesthesia parts are prepared. Pneumoperitoneum is created with Veress needle and metalic flap port of 10mm size is inserted through infraumbilical midline vertical incision. 12mm working port in right iliac fossa (RIF) is placed just lateral to mid-clavicular line and below level of McBurney's point. Five mm ports are inserted in right upper quadrant (RUQ) and left upper quadrant (LUQ) at mid clavicular line and in left iliac fossa (LIF) at mid-clavicular line at point corresponding to McBurney's point on right side [Figure 2]. Pressure of pneumoperitoneum is set at 12mm of Hg and flow at ten L/min.

Bottom Line: Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients.Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery.So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, Sterling Hospital, Ahmedabad, Gujarat, India.

ABSTRACT
Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA).

No MeSH data available.


Related in: MedlinePlus