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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

Division of right colonic vessels (Black arrow) close to colonic wall to preserve marginal artery. If ileocolic artery needs to be divided (Red arrow) to relieve tension on pouch- blood supply to pocuh from middle colic artery is preserved
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Figure 8: Division of right colonic vessels (Black arrow) close to colonic wall to preserve marginal artery. If ileocolic artery needs to be divided (Red arrow) to relieve tension on pouch- blood supply to pocuh from middle colic artery is preserved

Mentions: The next step is right colon mobilisation, for this surgeon and camera surgeon shift to left side and assistant shifts to right side of patient. Small intestine is folded in upper abdomen and root of mesentery is held between two graspers, at ileo-cecal and duodeno-jejunal junction in ‘Chinese Fan’ pattern [Figure 7a]. Thus, lifting ileo-colic pedicle, dissection is started from medial to lateral [Figure 7b].[7] Care is taken to avoid injury to duodenum, right ureter and gonadal vessels. Lateral attachments of right colon are divided [Figure 7c] and dissection is done till hepatic flexure [Figure 7d]. Right sided and transverse colonic pedicles i.e. ileo-colic, right colic and middle colic pedicles are not divided inside abdomen as this is done easily through midline mini laparotomy incision, close to colonic wall. This is important for pouch lengthening, so ileocolic artery may be divided [Figure 8].[8]


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)

Division of right colonic vessels (Black arrow) close to colonic wall to preserve marginal artery. If ileocolic artery needs to be divided (Red arrow) to relieve tension on pouch- blood supply to pocuh from middle colic artery is preserved
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: Division of right colonic vessels (Black arrow) close to colonic wall to preserve marginal artery. If ileocolic artery needs to be divided (Red arrow) to relieve tension on pouch- blood supply to pocuh from middle colic artery is preserved
Mentions: The next step is right colon mobilisation, for this surgeon and camera surgeon shift to left side and assistant shifts to right side of patient. Small intestine is folded in upper abdomen and root of mesentery is held between two graspers, at ileo-cecal and duodeno-jejunal junction in ‘Chinese Fan’ pattern [Figure 7a]. Thus, lifting ileo-colic pedicle, dissection is started from medial to lateral [Figure 7b].[7] Care is taken to avoid injury to duodenum, right ureter and gonadal vessels. Lateral attachments of right colon are divided [Figure 7c] and dissection is done till hepatic flexure [Figure 7d]. Right sided and transverse colonic pedicles i.e. ileo-colic, right colic and middle colic pedicles are not divided inside abdomen as this is done easily through midline mini laparotomy incision, close to colonic wall. This is important for pouch lengthening, so ileocolic artery may be divided [Figure 8].[8]

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