Laparoscopic Total Abdominal Colectomy for Emergent and Elective Indications: Perioperative Considerations and Techniques

Laparoscopic total abdominal colectomy has an established role in the treatment of inflammatory bowel disease and other benign conditions as well as synchronous neoplasms and/or hereditary colorectal cancer syndromes. There are well documented short- and long‑term benefits of laparoscopy which include reduced pain, bleeding, length of stay, and decrease in abdominal adhesions for subsequent operations. Laparoscopic total abdominal colectomy with end-ileostomy and defunctionalized rectosigmoid stump has become the most common initial operation for ulcerative colitis. Massive bleeding, colonic perforation and megacolon were traditionally an absolute contraindication to laparoscopy. However, as the technological advancement and surgical experience with laparoscopy have improved, both are considered a relative contraindication dependent on the specific circumstances. Direct laparoscopic manipulation of the colon should be minimized, particularly in the urgent setting, and laparoscopic ligation of the lymphovascular pedicles at their origin and complete mesocolic excision is required when the possibility of malignancy is a concern. With the clear benefits of laparoscopic total colectomy, it is in the best interest of the patient to perform these procedures laparoscopically, even in the emergent setting, if the surgeon deems it safe.