Laparoscopic total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis : initial experience in Mexico

• Published in: Surgical endoscopy Vol. 21; no. 12; pp. 2304 - 2307
• Main Authors: LOPEZ-ROSALES, F, GONZALEZ-CONTRERAS, Q, MURO, L. J, BERBER, M. M, CID DE LEON, H. T, FERNANDEZ, O. V, VEANA, R. R
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.12.2007; Springer Nature B.V
• Subjects: Adenomatous Polyposis Coli - surgery; Adult; Biological and medical sciences; Blood Loss, Surgical; Colitis, Ulcerative - surgery; Colon; Digestive system. Abdomen; Endoscopy; Feasibility Studies; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hernia - complications; Hospitals; Humans; Inflammatory bowel disease; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparotomy; Learning curves; Length of Stay; Male; Medical sciences; Mexico; Middle Aged; Ostomy; Other diseases. Semiology; Patients; Postoperative Complications; Proctocolectomy, Restorative - adverse effects; Proctocolectomy, Restorative - methods; Reoperation; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgeons; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical Wound Infection; Time Factors; Treatment Outcome; Central America; Mexico; America; Ileostomy; Colectomy; Small intestine; Wound; Inflammatory disease; Surgery; Ileal pouch; Intestinal disease; Endoscopy; Colon; Internal hernia; Human; Postoperative; Oral administration; Mucosectomy; Laparoscopy; Familial adenomatous polyposis coli; Genetic disease; Ileal pouch-anal anastomosis; Medicine; Treatment; Rectum; Digestive diseases; Familial adenomatous polyposis Ileal J pouch Proctocolectomy· Ulcerative colitis; Colitis; Ulcerative colitis
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-007-9523-2

Since the introduction of laparoscopic colectomy in 1991, experience in laparoscopic bowel surgery has gradually increased. Several reports from specialized centers have demonstrated that laparoscopic colorectal resections are feasible and safe, providing an acceptable alternative to laparotomy for a variety of diseases. Some studies have shown the feasibility, safety, and good functional outcome of the minimally invasive procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). No known studies have investigated laparoscopic proctocolectomy in México. This report aims to describe the first laparoscopic proctocolectomies with ileal pouch anal anastomosis (IPAA) performed at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán (INCMNSZ). All the patients in the authors' institution who underwent a one- or two-stage laparoscopic total proctocolectomy with IPAA between June 2005 and December 2006 were included in the study. All the operations were performed by the same surgeon, who had already completed the learning curve for colorectal laparoscopic procedures. For the study, 10 patients underwent a laparoscopic proctocolectomy with IPAA by a single surgeon. Eight of the patients underwent a one-stage procedure, whereas two patients with severe colitis underwent a two-step procedure. All the cases were managed with a diverting loop ileostomy. Six patients underwent a standard double-stapled IPAA anastomosis, and two patients with FAP underwent a mucosectomy with a manual IPAA anastomosis. The mean operative time was 187 min, and the mean blood loss was 46 ml. There were two postoperative complications. One patient presented with an early small bowel obstruction due to an internal hernia, which required reoperation. The other complication was a wound infection. The mean return to oral intake was 1.5 days, and the mean length of hospital stay was 3.4 days. Although this was not a comparative study and although sample size imposed limitations, with this preliminary data, we conclude that the laparoscopic approach to UC and FAP at our institution is safe, feasible, and effective. However, to achieve the benefits in postoperative outcome, this procedure should be performed only by experienced laparoscopic surgeons.