Three-Step Ileal Pouch-Anal Anastomosis under Total Laparoscopic Approach for Acute or Severe Colitis Complicating Inflammatory Bowel Disease

BackgroundA two- or three-step procedure is mandatory for restorative proctocolectomy in patients presenting with severe or acute colitis complicating inflammatory bowel disease (IBD). The aim of this study was to analyze the feasibility of a total laparoscopic approach for consecutive subtotal colectomy (STC) and secondary ileal pouch-anal anastomosis (IPAA).Study designAll patients underwent a three-step procedure that included first, a laparoscopic STC with ileostomy and sigmoidostomy; second, a laparoscopic proctectomy and IPAA, and third, closure of the temporary ileostomy.ResultsEighteen consecutive patients (7 women and 11 men), with a mean age of 39 ± 14 years (range 15 to 59 years) were included. Mean lengths of the procedures were 252 ± 59minutes for STC, and 286 ± 46minutes for IPAA, respectively. Two patients (11%) after laparoscopic IPAA required conversion into laparotomy. No patient died postoperatively. Four patients had reoperations after laparoscopic IPAA for intraperitoneal hemorrhage by laparotomy (n = 2) and by a transanal approach for anastomotic leakage (n = 2). The overall morbidity rate was 33% (12 of 36 procedures). Mean hospital stay was 8 ± 2 days after STC, and 10 ± 2 days after IPAA. After a mean follow up of 13months, all patients underwent intestinal continuity restoration.ConclusionsOur study suggests that a total laparoscopic approach is feasible and safe in inflammatory bowel disease patients with acute or severe colitis, not only for STC but also for IPAA after STC, with no mortality and an acceptable morbidity rate.