Restorative proctocolectomy

Abstract

The safety and feasibility of the laparoscopic restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) has been established as a standard option of surgical approach for ulcerative colitis (UC) patients. We perform this technique for most patients irrespective of severity of UC with satisfactory results. RPC consists of the combination of three operative procedures, namely, right hemicolectomy, left hemicolectomy, and low anterior rectal resection. The procedures start with the right-side colon mobilization by “inferior approach.” It is essential not to injure the ileocecal vessels for adequate blood supply to the ileal pouch. Subsequently, the left-side mesocolon is mobilized from the medial side, and the rectum is mobilized down to the pelvis. The pelvic autonomic nervous system must be preserved because of the benign and juvenile property of UC. Thereafter, the splenic flexure, the transverse colon, and the hepatic flexure are mobilized in this order. Finally, rectal mucosectomy is performed transanally, and the constructed 15-cm-long ileal J-pouch is delivered to the anus. IPAA is achieved by hand sewing. Here, we describe the surgical procedures of laparoscopic RPC with IPAA.