Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

Abstract

Aim Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler. In an attempt to overcome these difficulties we have used the technique of transanal rectal excision to perform the proctectomy. This paper describes the technique, which is combined with an abdominal approach using a single-incision platform (SIP).Method Data were collected prospectively for consecutive operations between May 2013 and October 2015, including all cases of restorative proctocolectomy with ileoanal pouch anastomosis performed laparoscopically. Only patients having a transanal total mesorectal excision (TaTME) assisted by SIP were included. The indication for RPC was ulcerative colitis (UC) refractory to medical treatment. ResultsThe procedure was performed on 16 patients with a median age of 46 (26-70) years. The male:female ratio was 5:3 and the median hospital stay was 6 (3-20) days. The median operation time was 247 (185-470) min and the overall conversion rate to open surgery was 18.7%. The 30-day surgical complication rate was 37.5% (Clavien-Dindo 1 in four patients, 2 in one patient and 3 in one patient). One patient developed anastomotic leakage 2 weeks postoperatively.Conclusion This initial study has demonstrated the feasibility and safety of TaTME combined with SIP when performing RPC with ileal pouch-anal anastomosis for UC.Keywords Ulcerative colitis, RPC, laparoscopy, single incision laparoscopic surgery, IBD, IPAA What does this paper add to the literature? The paper reports the novel approach of combining single-incision surgery and transanal rectal excision for restorative proctocolectomy. The technique has the ability to minimize surgical trauma and allow safe distal rectal dissection, especially in men with a narrow pelvis.

Transanal completion proctectomy with close rectal dissection and ileal pouch‐anal anastomosis for ulcerative colitis

“…Although no large studies have been conducted yet, a few studies have shown promising results by using ta-TME to treat UC. In a small series, Leo et al reported the outcomes of 16 patients treated with hybrid single-incision surgery combined with ta-TME for ileoanal pouch construction (20). There was only one anastomotic leak, and three cases with conversion to open surgery.…”

The role of transanal total mesorectal excision in rectal surgery

“…Leo et al [32] reported their experience of 16 total proctocolectomies and ileal pouch anal anastomoses (TPC + IPAA) for refractory mucosal ulcerative colitis using TaTME-assisted single port laparoscopy. The median operative time was 247 (185-470) min and the overall conversion rate to open surgery was 18.7%.…”

Redo pouch and re‐stapled anastomosis after intra‐operative detection of pouch ischaemia by fluorescence angiography – a video vignette

“…A 45‐year‐old patient who had undergone subtotal laparoscopic colectomy for refractory ulcerative colitis in 2016 was scheduled for completion proctectomy with transanal total mesorectal excision (TaTME) and IPAA. Completion proctectomy with TaTME was accomplished with a combined transanal and transabdominal technique using two single ports, as previously described . The specimen was retrieved through the stoma site.…”