2009, Number 3
Total laparoscopic proctocolectomy with colonic "J" pouch reconstruction in patients with chronic ulcerative colitis
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ABSTRACTObjectives: To determine if the laparoscopic approach for total proctocolectomy with an ileal pouch anal anastomosis in patients with chronic idiopathic ulcerative colitis (CIUC) has a lower risk of short term postoperative complications and to evaluate the surgical time. Setting: National institute of Medical Sciences and Nutrition "Salvador Zubirán". Third level health care center. Design: Prospective, observational, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables and central tendency measures. Patients and methods: Fifteen patients with CIUC subjected to total laparoscopic proctocolectomy with ileal-pouch anal anastomosis during the period from June 2005 to March 2008. Studied variables were: age, gender, indication for surgery, immunosupressive therapy, surgical time, blood loss, conversion, complications, re-intervention, re-admittance. Results: Age, 32 years (19-68). Indications for surgery: in 10 (66.6%) failure of medical treatment, 3 (20%) intolerance to medical treatment, and 2 (13.3%) toxic colitis. In 13 patients (86.6%) the procedure was performed in two times and in two patients in three times. All patients were managed with loop ileostomy for protection. In 13 patients (86.6%) ileal pouch-anal anastomosis was performed with double stappling and in two (13.3%) the procedure was performed manually because stapplers failed; this was considered as surgical complication. Surgical time was 180 min (120- 240). Surgical bleeding was 90 ml (10-200). Postoperative ileus occurred in the first surgical time and another occurred when closing a diverting ileostomy, and a pulmonary thromboembolism. Mean time to start oral feeding was of 3 days (2-4). The mean in-hospital stay was of 5 days (3-8). Conclusions: Complications were similar to those reported in other series of the same or larger size. Surgical time was lower than previously reported.
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