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Laparoscopic proctocolectomy with restorative ileal-anal pouch

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23/04/2006

Laparoscopic proctocolectomy with restorative ileal-anal pouch
T. S. Gill, A. Karantana, J. Rees, S. Pandey and A. R. Dixon
 Abstract

Objective  The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery.

Methods  A prospectively collected electronic database of all colorectal laparoscopic procedures performed between April 2001 and July 2003 has been used to identify surgical outcomes in 14 consecutive patients who have undergone laparoscopic RPC.

Results  Fourteen patients (5 male), median BMI 24 kg/m2 have undergone restorative laparoscopic proctocolectomy over a two year period: 13 (ulcerative colitis, one with cancer) and 1 (FAP). The median operation time was 260 min; time has not decreased with experience. There were no intra-operative surgical complications or deaths. Patient controlled analgesia continued for a median of 36 h. The median time to diet was 48 h and median hospital stay 7 days; three patients required nasogastric aspiration for delayed gastric emptying. Eighteen regional lymph nodes were retrieved local to the carcinoma. There was one anastomotic leak. All covering stomas were closed by 6 months (12 by eight weeks). All 14 patients are fully continent, able to suppress urgency and have a median pouch frequency of 4/24 h. None admit to having problems with potency, orgasm sensation, ejaculation, micturition. One lady reports dysparunia. All are highly satisfied with functional outcome and cosmesis.

Conclusion  We are encouraged to continue to offer our patients the option of a laparoscopic resection.


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