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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) Relaparoscopy with help of disk device (b) Attaching anvil to EEA stapler (c) Orienting pouch before firing stapler (d) Final appearance of abdomen at completion of surgery
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Figure 10: (a) Relaparoscopy with help of disk device (b) Attaching anvil to EEA stapler (c) Orienting pouch before firing stapler (d) Final appearance of abdomen at completion of surgery

Mentions: Re-laparoscopy is done with help of disk device [Figure 10a]. Per rectally EEA stapler gun is inserted and anvil is fixed to its head [Figure 10b]. Pouch tension is judged and if required pouch lengthening manoeuvres are done to decrease tension on pouch. Anterior stapler line is kept anterior [Figure 10c] and after confirming this, stapler is fired and doughnuts are checked for adequacy. Pouch is checked for leaks with insufflating air in pouch while pelvis is filled with saline. After confirming hemostasis and instrument count one large bore drain is inserted in pelvis through RIF port. Loop ileostomy is created in single layer with absorbable stitches in RIF [Figure 10d]. Abdomen is closed in layers.


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) Relaparoscopy with help of disk device (b) Attaching anvil to EEA stapler (c) Orienting pouch before firing stapler (d) Final appearance of abdomen at completion of surgery
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 10: (a) Relaparoscopy with help of disk device (b) Attaching anvil to EEA stapler (c) Orienting pouch before firing stapler (d) Final appearance of abdomen at completion of surgery
Mentions: Re-laparoscopy is done with help of disk device [Figure 10a]. Per rectally EEA stapler gun is inserted and anvil is fixed to its head [Figure 10b]. Pouch tension is judged and if required pouch lengthening manoeuvres are done to decrease tension on pouch. Anterior stapler line is kept anterior [Figure 10c] and after confirming this, stapler is fired and doughnuts are checked for adequacy. Pouch is checked for leaks with insufflating air in pouch while pelvis is filled with saline. After confirming hemostasis and instrument count one large bore drain is inserted in pelvis through RIF port. Loop ileostomy is created in single layer with absorbable stitches in RIF [Figure 10d]. Abdomen is closed in layers.

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