It was reported via journal article: title: laparoscopic restorative proctocolectomy: safety and critical level of the ileal pouch anal anastomosis.Authors: s.E.Duff; p.M.Sagar; m.Rao; d.Macafee; t.El-khoury.Citation: the association of coloproctology of great britain and ireland.14, 2011; 883¿886; doi: doi:10.1111/j.1463-1318.2011.02810.X.The aim of this prospective study was to report the longer-term results of laparoscopic-assisted restorative proctocolectomy (rpc), with particular reference to safety and the level of the stapled ileal pouch-anal anastomosis (ipaa).From july 2006 to july 2010, 75 patients (male=34; median age= 35 years, age range=15 ¿ 72 years) underwent rpc with ipaa.During the procedure, the rectum was mobilized laparoscopically as far as the pelvic floor, then a small (6 cm) pfannenstiel incision was made to complete the pelvic dissection and to allow placement of a linear contour device (ethicon) to divide the rectum at the pelvic floor level.The pouch was constructed using two limbs of 20 cm of ileum with two to three firings of a linear stapler (tlc 75; ethicon) and a double stapled end-to-end anastomosis was constructed with a circular stapler (els 29; ethicon).Reported early postoperative complications included pelvic abscess/collection (n=6) which 4 patients were readmitted; ileus/small bowel obstruction (n=5) in which 2 patients were readmitted and managed conservatively; minor wound infection (n=4) in which 2 patients were readmitted; postoperative bleedings (n=1); mesenteric thrombosis (n=1); abdominal pain (n=3) which the patients were readmitted; radiological leakage (n=5); small leak from blind end of the j pouch (n=1); anastomotic stricture (n=1); long -term complication included pouchitis (n=18); pouch-anal anastomotic stricture (n=9) which required dilatation under anaesthetic; poor function (n=6) in which two patients required an ileostomy; small bowel obstruction secondary to a band adhesion (n=1) which required a laparotomy in the second trimester of pregnancy.In conclusion, in laparoscopic-assisted rpc a limited pfannenstiel incision allows safe construction of the ipaa at an appropriate level.Laparoscopic rpc is safe and the emerging long-term follow-up data show the benefit of this approach, with very low rates of small bowel obstruction and incisional hernia formation.
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