Hand-assisted laparoscopic restaurative proctocolectomy : surgical technique and results in the therapy of Familial Adenomatous Polyposis and Ulcerative Colitis

This video shows the surgical laparoscopic technique used in our experience to perform total colectomy and ileo-pouch-anal anastomosis (IPAA) for the therapy of Familial Adenomatous Polyposis (FAP) and Ulcerative Colitis (UC). Surgical details are outlined, particularly regarding laparoscopic hand-assisted total colectomy (HAL), proctectomy and rectal pathologic mucosa complete removal with transanal mucosectomy, ileal reservoir preparing and ileo-pouch-anal anastomosis manual suturing. Furthermore late endoscopic and functional controls of the ileal reservoir are shown. This video also reports our series and compared peri-operative parameters and outcomes achieved with hand-assisted laparoscopic technique VS. open surgery (OS): we have reported data of 111 patients, from January 1996 to September 2006. Our results demonstrate that surgery timing was similar in both techniques, once completed the short learning curve for hand-assisted laparoscopy. Patients who underwent laparoscopic surgery needed significantly less analgesic therapy in the post-operative phase, they had an earlier resumption of oral intake and an overall shorter hospitalisation. Furthermore HAL patients had a shorter incision, less blood loss and less major complications. There was no significant difference regarding minor complication. No patient needed intra-operative conversion from laparoscopic approach to conventional open surgery and mortality rate was 0%. Conclusions: by means of this video the authors emphasize that Hand-assisted laparoscopic surgery performing IPAA is safe and that it offers better therapeutic results than open surgery, in terms of peri-operative parameters. Overall, in the surgical management of FAP and UC, this laparoscopic approach allows to combine the convenience and safety of open surgery with the advantages of traditionallaparoscopic surgery, maintaining the possibility of a radical treatment of the disease and offering better aesthetic and functional results.