Laparoscopic Total Abdominal Colectomy for Severe Ulcerative Colitis

INTRODUCTION: The patient is an 18 year-old female with severe ulcerative colitis refractory to medical management. At presentation her hematocrit was 15 and her albumin was 2.1. Our practice is perform a total abdominal colectomy with end ileostomy as the initial procedure in ulcerative colitis patients who are malnourished and immunocompromised. This is followed by a proctectomy with ileal pouch-anal anastamosis in 6 months after the patient is off immunosuppression and nutritionally replete. This video demonstrates our technique for laparoscopic total abdominal colectomy and end ileostomy.
METHODS: 5 ports are placed with the right lower quadrant port serving as the final ileostomy site. The ileocolic pedicle is elevated, dissected and divided with an energy source. After pedicle division, the medial to lateral mobilization of the right colon continues in a cephalad direction up to the transverse colon. The hepatic flexure and terminal ileum and then mobilized. The omentum is dissected off the transverse colon and the middle colic vessels are divided. The splenic flexure and left colon are mobilized. A window is created in the sigmoid mesentery and the sigmoid colon is divided with a endoscopic stapler. The specimen is extracted through a 3 am suprapubic incision and the rectal stump is implanted in the subcutaneous tissues of this incision. The incision is closed and an ileostomy aperture is created at the right lower quadrant port site and an end ileostomy is fashioned.
RESULTS: The operative procedure lasted one hour and 40 minutes with an estimated blood loss of 35 ml. She had an uneventful recovery and was discharged home on postoperative day 4.
CONCLUSIONS: This procedure demonstrates the safety and benefit of the laparoscopic approach in cases with profound immunosuppression, anemia and malnutrition.

Session: Podium Presentation

Program Number: V006