Laparoscopic total proctocolectomy with ileal J pouch-anal anastomosis

BACKGROUND/AIMS: Minimally invasive surgery has developed as one of the mos t important advances in surgical techniques, The laparoscopic procedure has been successfully used to perform colonic resections, Inflammatory bowel d iseases like ulcerative colitis (UC) and familial adenomatous polyposis (FA P) appear as a main indication for total laparoscopic proctocolectomy. METHODOLOGY: At the Second Department of Surgery of the "Regina Elena" Inst itute for Cancer Research, 5 non-selected patients were submitted within a 3-year period (1993-1996) to a total laparoscopic proctocolectomy with a re storative ileal J pouch-anal anastomosis. They comprised 3 males suffering from UC and 2 females affected by FAP. RESULTS: No patients undergoing laparoscopic procedure were converted. The average operative time was 364min (480min in the first case,290min in the f ifth ease). There were no intra-operative or postoperative complications (e xcept a mild peritoneal bleeding in the first case, spontaneously stopped). Post-operative pain was mild and no analgesics were required. Late results were excellent, with good bowel function within 1 year after the operation , without dietetic, working and sport restrictions and without sexual disor ders, mainly in males, CONCLUSIONS: Laparoscopic total proctocolectomy in the hands of skilled lap aroscopic surgeons is a feasible, safe; and effective procedure, with early and late results comparable to, and in some aspects better than, those obt ained with "open" surgery. Moreover, it does not have the disadvantage of i ntra-operative fluid loss, prolonged post-operative ileus, pain and, in you nger patients, psychological discomfort of the wide scar.