One-stage Laparoscopic Restorative Proctocolectomy: an Alternative to the Conventional Approach?

Purpose: There is significant concern in the current literature over the safety of laparoscopic techniques in removal of the entire colon and rectum. The purpose of this study was to examine the results of a one-stage laparoscopic-assisted restorative proctocolectomy in patients with mucosal ulcerative colitis and familial adenomatous polyposis in a single institution experience.

Methods: All patients who underwent laparoscopic-assisted one-stage restorative proctocolectomy (29 mucosal ulcerative colitis; 3 familial adenomatous polyposis) over a 24-month period were followed up prospectively for short-term and long-term complications and functional outcome.

Results: There were 32 patients (17 males), with a median age of 32 years (range, 16-29 years). There were no conversions to open surgery. There were two intraoperative complications, an inconsequential rectal perforation during mobilization and one staple line misfire. There were 11 postoperative complications: 3 obstruction/ileus, 2 pouchitis, 2 wound infections, 2 strictures, 1 pelvic abscess, and 1 pouch leak (at the top of the "J"). Three patients required reoperation (1 temporary ileostomy, 1 lysis of adhesions, and 1 transpouch drainage). The median number of bowel movements was seven per day (range, 2-15).

Conclusion: A one-stage laparoscopic-assisted restorative proctocolectomy can be performed effectively and safely. Given that techniques in laparoscopic large-bowel surgery are still evolving rapidly, the role of this operation in the surgical treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis is likely to expand in the near future.