Laparoscopy-Assisted Proctocolectomy for Ulcerative Colitis: A More Rational Approach

Abstract

Purpose

: To evaluate a modified approach to a proctocolectomy for ulcerative colitis using a laparoscopy-assisted technique.

Methods

: Four 5-mm ports (epigastric, umbilical, and left and right lower quadrants) are used for colonic mobilization without ligation of the mesenteric vessels. A low suprapubic transverse incision is then made, and the colon is pulled out with sequential ligation of mesenteric vessels. The remainder of the endorectal dissection and pull-through is performed in a conventional manner. At the end of the procedure, the right lower quadrant port site is converted to an ileostomy.

Results

: Seven patients underwent this approach over 2 years. There were five girls, and the mean age was 10.3 ± 3.9 years. All operations were successfully performed, and the mean operating time was 8.5 ± 1.1 hours. The operative time decreased from 10 hours for the first case to 7.25 hours for the last case. The mean number of hospital days was 5.5 ± 0.5. There was one postoperative small-bowel obstruction, which was treated laparoscopically. Children undergoing the laparoscopy-assisted approach started enteral feedings at 2.0 ± 0.3 days and required 2.2 ± 0.6 days of postoperative intravenous narcotics.

Conclusion

: A laparoscopy-assisted approach to ulcerative colitis can result in a reduction of scar size compared with a conventional open laparotomy, with similar clinical outcomes.