A Case of Total Proctocolectomy by Reduced Port Surgery for Refractory Ulcerative Colitis

Abstract

: We report the case of a 40-year-old woman with refractory ulcerative colitis UC whose condition did not improve despite aggressive medical therapy with a corticosteroid and an immunosuppressor. The patient underwent a total proctocolectomy by reduced port surgery RPS . A vertical incision of 30 mm was made through the umbilicus, and a laparoscope port and two working or assistant laparoscopic ports were inserted through the fascia. A 5 mm port was used as the terminal ileostomy site and another 5 mm port was used as a drain site marked preoperatively . The operator used a standard laparoscopic 5 mm atraumatic grasper for the left hand and a standard laparoscopic dissector or an Enseal energy device for the right hand. An ileal J-pouch was created extra-corporeally from the terminal ileum and then an ileal pouch-anal anastomosis IPAA was created by hand suturing. The diverting loop ileostomy was brought out through the right iliac fossa, and there was 30 cm of ileum between the diverting loop ileostomy and the IPAA. The surgical procedures were very similar to those normally used in laparoscopic colectomy. The duration of the surgery was 465 min, and blood loss was estimated at 240 ml. No intraoperative complications occurred, and conversion to conventional laparoscopic or open surgery was not needed. Laparoscopic total proctocolectomy using RPS compared with standard laparoscopic surgery may be preferred for young women because it reduces the wound size, minimizes postoperative pain, and enhances cosmesis.