Restorative proctocolectomy with an ileoanal pouch: the role of laparoscopy

ABSTRACT Objectives: the aim of this retrospective study was to evaluateearly experience with laparoscopic restorative proctocolectomy byanalyzing the perioperative results of surgical treatment.Patients and methods: seven major surgeries were per-formed in six patients with familial adenomatous polyposis and ul-cerative colitis. All procedures were performed under laparoscopyat our third-level hospital from June 2003 to October 2004.Results: mean surgical time was 287.5 ± 80.7 min, and me-dian blood loss was 300 ± 249.0 cc. There were no conversions;return of peristalsis began at 32 ± 12.4 h; average time to firstoral intake was 64.0 ± 32.8 h, and mean duration of hospital staywas 9.3 ± 1.2 days. There was one case of perineal sepsis due toileal pouch-anal anastomotic leakage, which was successfullytreated with oral intake restriction, parenteral nutrition, and intra-rectal drainage. The most common postoperative complicationwas postoperative ileus.Conclusions: we believe that the laparoscopic approach torestorative proctocolectomy may be considerably improved in ourcenter. Particular aspects for improvement include efforts toachieve lower operating and hospitalization times to equate ourresults with those reported by multicenter studies for laparoscopiccolon cancer surgery. In our opinion, learning and further trainingopportunities should be encouraged to improve surgeon experi-ence in the field of laparoscopy, preferably at centers specializingin restorative proctocolectomy.Key words:Restorative proctocolectomy. Ileoanal pouch. La-paroscopy. Surgery.