Laparoscopic Subtotal Proctocolectomy

(1)

Department of Gastrointestinal Surgery, Kameda Medical Center, Kamogawa, Japan

Keywords

Laparoscopic subtotal proctocolectomyIleorectal anastomosisIntersphincteric resection of the rectum

8.1 Introduction

Proctocolectomy and ileorectal anastomosis is a surgical procedure indicated for familial adenomatous polyposis proposed by Lockhart-Mummery [1] that takes into account the quality of life. In recent years, this method has represented a step forward, and subtotal proctocolectomy (total colectomy and lower anterior resection of the rectum) has begun to be performed using laparoscopic surgery procedures. Lymph node dissection for combined colorectal cancer is also possible with laparoscopic surgery.

In addition, using the intersphincteric resection of the rectum (ISR) procedure, it is possible to resolve almost any issue encountered in colorectal surgery, for example, ileal pouch-anal anastomosis (IPAA).

Through the understanding the fascial composition of the large intestine and integrating the surgical procedure to each site of the large intestine, subtotal and total coloproctectomy can be performed.

8.2 Resection Range and Dgree of Lymph Node Dissection

The area of the entire colon and most of the rectum is considered the resection range. For comorbid cancers, laparoscopic subtotal proctocolectomy and subtotal proctocolectomy with laparotomy are similar in terms of resection range and degree of lymph node dissection, with respect to other interventional approaches in the abdominal cavity. Lymph node dissection of the transverse colon is performed through a supra-umbilical incision.

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