Minimally invasive total proctocolectomy with Brooke ileostomy for ulcerative colitis

Abstract

Minimally invasive total proctocolectomy with Brooke ileostomy is a safe, feasible option for the surgical treatment of chronic ulcerative colitis, and is the procedure of choice for select patients.

Factors associated with postoperative morbidity, reoperation and readmission rates after laparoscopic total abdominal colectomy for ulcerative colitis

“…The overall postoperative morbidity rate of 39.7% reported in the present study falls within the 16-60% range reported from current laparoscopic TAC series (Table 4) and is also consistent with the 40.1% morbidity reported in a review of pooled data from the past decade [4]. This wide variability in reported complications depends at least in part on the definitions of morbidity and patient case mix, which limits the value of interstudy comparisons [9][10][11]13,14]. The reported morbidity in the present study has several characteristics.…”

“…The incidence of individual complications is similar to that reported by others ( Table 4). The 15% incidence of distal stump leakage is in sharp contrast with the current literature on laparoscopic TAC, in which it has been either reported sporadically [11,12] or more often not at all [5,[7][8][9][10][13][14][15]27], including in the initial report from our own institution [6]. The complication rate was reported in a systemic review to be 6.7% after open TAC and a rate as high as 35% was reported after subcutaneous stump placement even in a tertiary institution [4,28].…”

“…In a recent systematic review of pooled data from studies published from 1975 to 2007, the 30-day operative morbidity and mortality rates associated with open surgery for severe colitis were as high as 40.1 and 1.8%, respectively, even in patients operated on in the last decade [4]. There are several comparative studies indicating that laparoscopic TAC is a safe and feasible alternative to open colectomy in selected patients requiring surgery for severe UC [5][6][7][8][9][10][11][12][13][14][15]. Moreover, there is evidence that the recovery benefit of initial laparoscopic TAC can facilitate subsequent pouch surgery [11,12,14,16].…”

“…There are several comparative studies indicating that laparoscopic TAC is a safe and feasible alternative to open colectomy in selected patients requiring surgery for severe UC [5][6][7][8][9][10][11][12][13][14][15]. Moreover, there is evidence that the recovery benefit of initial laparoscopic TAC can facilitate subsequent pouch surgery [11,12,14,16]. However, data are still limited on the specific factors that may be associated with the outcome after laparoscopic TAC for UC.…”

Effects of minimizing access trauma in laparoscopic colectomy in patients with IBD

“…In addition to the conventional access for these resections, laparoscopic procedures are available that reduce invasiveness. The laparoscopic approach was first described by Jacobs et al in 1991 andFranklin et al in 1993 [5, 6] and has since become a standard access [7][8][9][10]. Laparoscopic-assisted resection (LAR) requires an additional incision to remove the resected specimen, while total laparoscopic resection (LR) further reduces the access trauma [11][12][13].…”