Single-port Laparoscopic Restorative Proctocolectomy with Ileal-pouch Anal Anastomosis Using the Left Lower Quadrant Ileostomy Site

Cigdem Benlice, Emre Gorgun. Cleveland Clinic, Department of Colorectal Surgery

Introduction: In this video, we demonstrate single port laparoscopic restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) through the left lower quadrant ileostomy site in a three-stage fashion.

Methods and Procedures: This 39-year-old female presented to the Department of Colorectal Surgery, Cleveland Clinic with a medical-refractory ulcerative colitis. Since the patient has a congenital atrophia in her right upper extremity, a right ileostomy site was deemed inappropriate for her and a decision was made to use the left lower quadrant for the ileostomy. The operation was performed in a modified lithotomy position through the single port access. First-stage of RPC started from the right colon initially by medial dissection of the ileocolic and middle colic artery, respectively. Inferior mesenteric artery was left intact and rectosigmoid junction was stapled. Ultimately, the colon was exteriorized from the ileostomy site. Ileostomy was matured and rectal stump was left in pelvis with no implantation. Six months after laparoscopic total colectomy, patient was taken to the operating room for the second-stage procedure. After release of the terminal ileostomy, single port access was placed to the ileostomy site. The inferior mesenteric artery was ligated at the superior rectal artery level and through the avascular plane, mesorectum was dissected totally down to the level of the pelvic floor. Rectum was transsected and a 15-20 cm ileal pouch was created extracorporeally. Subsequently, under laparoscopic view, intracorporeal anastomosis was created and pouchoscopy was performed. This was consistent with negative leak. Ultimately, a diverting loop ileostomy was built.

Results: The patient was started a liquid diet on the day after surgery. There was no perioperative complication.

Conclusion: Single-port laparoscopic restorative proctocolectomy with IPAA through the left lower quadrant ileostomy site is technically feasible and safe. 

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