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Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative colitis

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Abstract

Background

Sub-total colectomy and restorative proctocolectomy with j-pouch ileo-anorectal anastomosis is the treatment of choice in children with ulcerative colitis uncontrolled with medical therapy.

Objective

To present some technical considerations about children undergoing laparoscopic ileal-J-pouch anorectal anastomosis.

Settings and patients

All patients with ulcerative colitis undergoing laparoscopic ileal-J-pouch anorectal anastomosis were evaluated from January 2006 to February 2011.

Intervention

The new technical innovations herein are (1) total laparoscopic approach, (2) a very short 3-cm J-pouch ileal reservoir created outside the stoma incision, (3) preservation of the entire anal canal and the Knight-Griffen double stapled anastomosis, less than 3 cm from the dentate line, (4) use of a Multiple Instrument Access Port system in the stoma skin incision to reduce the number of port site incisions and (5) proctectomy performed using only an electrosurgical vessels sealing device thus avoiding clips to close rectal pedicle.

Results

Seventeen laparoscopic ileo J-pouch low rectal anastomosis were performed by the same surgical staff. Three complications occurred postoperatively: one bowel obstruction, one ileostomy prolapse, and one anastomotic stricture. Satisfactory functional results were achieved in all, there was no significant perineal excoriation and quality of life was excellent.

Conclusions

A Multiport Instrument Access Port placed in the stoma site allowed the use of more instruments through a single incision. The very short ileo J-pouch low rectal anastomosis has been shown to be a safe, feasible, and effective reconstructive procedure.

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Conflict of interest

No competing financial interests exist.

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Authors and Affiliations

  1. Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147, Genova, Italy

    Girolamo Mattioli, Edoardo Guida, Alessio Pini-Prato, Stefano Avanzini, Valentina Rossi & Vincenzo Jasonni

  2. Paediatric Gastroenterology Department, Giannina Gaslini Institute, Genova, Italy

    Arrigo Barabino

  3. Section of Pediatric Surgery, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI, USA

    Arnold G. Coran

Authors
  1. Girolamo Mattioli
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  2. Edoardo Guida
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  3. Alessio Pini-Prato
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  4. Stefano Avanzini
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  5. Valentina Rossi
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  6. Arrigo Barabino
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  7. Arnold G. Coran
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  8. Vincenzo Jasonni
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Correspondence to Edoardo Guida.

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Mattioli, G., Guida, E., Pini-Prato, A. et al. Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative colitis. Pediatr Surg Int 28, 351–356 (2012). https://doi.org/10.1007/s00383-011-3030-1

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  • DOI: https://doi.org/10.1007/s00383-011-3030-1

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