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Laparoscopic Abdominoperineal Resection and Total Proctocolectomy with End Ileostomy

  • Giovanna da Silva
  • Steven D. Wexner
Chapter

Abstract

Laparoscopic abdominoperineal resection is a common surgical procedure, usually performed for low rectal tumors, mid-rectal tumors in patients with a weak sphincter mechanism, and for recurrent or residual anal cancer. It is usually performed using three to four ports, following the same principles as open surgery, with an advantage of avoiding a major incision as the specimen is retrieved through the perineum. Surgical pitfalls include those problems seen during open surgery such as ureteric, autonomic nerve and vascular injuries, and in addition injury to the epigastric vessels during port placement. Laparoscopic total proctocolectomy with end ileostomy is generally undertaken for patients with extensive colonic Crohn’s disease involving the rectum with or without perianal disease, for familial adenomatous polyposis or patients with ulcerative colitis who decline or are not candidates for restorative procedures. The procedure is performed with five ports including the camera port. The pitfalls of the technique include those issues seen in the abdominoperineal resection, plus injury to the duodenum and right ureter during right colon mobilization. Postoperative care is similar for both procedures; patients are started on a clear liquid diet on the day of surgery and diet is advanced as tolerated. The bladder catheter is kept in place for about 3 days. Patients can often be discharged home after 4–5 days. In patients with an end ileostomy, care is taken to strictly measure the ileostomy output, and start antidiarrheal medications as needed prior to discharge.

Keywords

Familial Adenomatous Polyposis Abdominoperineal Resection Perineal Wound Epigastric Vessel Inferior Hypogastric Plexus 
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Further Reading

  1. Baker R, White E, Titu L, et al. Does laparoscopic abdominoperineal resection of the rectum compromise long-term survival? Dis Colon Rectum. 2002;45:1481–5.PubMedCrossRefGoogle Scholar
  2. Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2006;(4):CD005200.Google Scholar
  3. Ng S, Leung K, Lee J, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol. 2008;15:2418–25.PubMedCrossRefGoogle Scholar
  4. Roh M, Colangelo L, O’Connell M, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27:5124–30.PubMedCrossRefGoogle Scholar
  5. Yamamoto S, Fukunaga M, Miyajima N, Okuda J, et al. Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients. J Am Coll Surg. 2009;208:383–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryCleveland Clinic FloridaWestonUSA
  2. 2.Department of SurgeryFlorida International University College of MedicineMiamiUSA
  3. 3.Department of SurgeryFlorida Atlantic University College of MedicineBoca RatonUSA

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