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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) Minilaparotomy incision (b) Removed specimen of total colon with rectum cut open (c) Applying linear GIA 80 stapler to create ileal pouch (d) Anvil of EEA stapler fixed at the end of ileal pouch
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Figure 9: (a) Minilaparotomy incision (b) Removed specimen of total colon with rectum cut open (c) Applying linear GIA 80 stapler to create ileal pouch (d) Anvil of EEA stapler fixed at the end of ileal pouch

Mentions: Midline vertical 6 to 7 cm incision is kept skirting around umbilicus and entire small intestine is delivered out of wound to examine for any injury [Figure 9A]. Then small intestine is placed inside and colon is taken out with mesocolon. Mesocolon is divided near colon with help of Ligasure device. Vessels are sealed and ligated with silk ligature at required places i.e. named major pedicles like middle colic and ileo-colic. Specimen is removed and cut section is examined for any suspicious area of malignancy [Figure 9b]. Pouch of terminal ileum is created 15cm long by firing two linear GIA 80mm staplers [Figure 9c].[9] Haemostasis is secured inside pouch at stapler line and pouch is flushed with saline. Anvil of EEA no.28 stapler is fixed to distal end of pouch [Figure 9d]. Ileostomy site is marked with cautery at this stage and small feeding tube is placed across mesenteric window for easy identification on re-laparoscopy.


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) Minilaparotomy incision (b) Removed specimen of total colon with rectum cut open (c) Applying linear GIA 80 stapler to create ileal pouch (d) Anvil of EEA stapler fixed at the end of ileal pouch
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: (a) Minilaparotomy incision (b) Removed specimen of total colon with rectum cut open (c) Applying linear GIA 80 stapler to create ileal pouch (d) Anvil of EEA stapler fixed at the end of ileal pouch
Mentions: Midline vertical 6 to 7 cm incision is kept skirting around umbilicus and entire small intestine is delivered out of wound to examine for any injury [Figure 9A]. Then small intestine is placed inside and colon is taken out with mesocolon. Mesocolon is divided near colon with help of Ligasure device. Vessels are sealed and ligated with silk ligature at required places i.e. named major pedicles like middle colic and ileo-colic. Specimen is removed and cut section is examined for any suspicious area of malignancy [Figure 9b]. Pouch of terminal ileum is created 15cm long by firing two linear GIA 80mm staplers [Figure 9c].[9] Haemostasis is secured inside pouch at stapler line and pouch is flushed with saline. Anvil of EEA no.28 stapler is fixed to distal end of pouch [Figure 9d]. Ileostomy site is marked with cautery at this stage and small feeding tube is placed across mesenteric window for easy identification on re-laparoscopy.

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