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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

(a) Dissection of lateral pedicles of rectum (b) Anterior dissection of rectum below peritoneal reflection(c) Adjusting Endo GIA roticulating 45mm stapler over rectum at proposed line of division after confirmation (d)Rectal stump after low division of rectum with stapler
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Figure 6: (a) Dissection of lateral pedicles of rectum (b) Anterior dissection of rectum below peritoneal reflection(c) Adjusting Endo GIA roticulating 45mm stapler over rectum at proposed line of division after confirmation (d)Rectal stump after low division of rectum with stapler

Mentions: Next rectal mobilisation is done, which is similar to total mesorectal excision (TME). Care is taken to avoid injury to inferior hypogastric nerves on sidewall of pelvis during posterior dissection. Lateral pedicles are divided and haemostasis is secured by dividing middle rectal vessels [Figure 6a] with ultrasonic shears. Anterior dissection is done posterior to Denonvilliers’ fascia in males and between rectum and posterior wall of vagina in females [Figure 6b] with monopolar cautery. Dissection is done upto the level of anorectal junction, which is confirmed by per rectal digital examination by OT assistant. After achieving adequate circumferential clearance two cartridges of Endo GIA 45 mm roticulating stapler are fired [Figure 6c], leaving 1–2 cm rectal stump [Figure 6d].


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)

(a) Dissection of lateral pedicles of rectum (b) Anterior dissection of rectum below peritoneal reflection(c) Adjusting Endo GIA roticulating 45mm stapler over rectum at proposed line of division after confirmation (d)Rectal stump after low division of rectum with stapler
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: (a) Dissection of lateral pedicles of rectum (b) Anterior dissection of rectum below peritoneal reflection(c) Adjusting Endo GIA roticulating 45mm stapler over rectum at proposed line of division after confirmation (d)Rectal stump after low division of rectum with stapler
Mentions: Next rectal mobilisation is done, which is similar to total mesorectal excision (TME). Care is taken to avoid injury to inferior hypogastric nerves on sidewall of pelvis during posterior dissection. Lateral pedicles are divided and haemostasis is secured by dividing middle rectal vessels [Figure 6a] with ultrasonic shears. Anterior dissection is done posterior to Denonvilliers’ fascia in males and between rectum and posterior wall of vagina in females [Figure 6b] with monopolar cautery. Dissection is done upto the level of anorectal junction, which is confirmed by per rectal digital examination by OT assistant. After achieving adequate circumferential clearance two cartridges of Endo GIA 45 mm roticulating stapler are fired [Figure 6c], leaving 1–2 cm rectal stump [Figure 6d].

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