Laparoscopic Subtotal or Total Colectomy or Proctocolectomy and Ileal Pouch Anal Anastomosis

Experience has shown favorable results in patients undergoing urgent laparoscopic colectomy for acute ulcerative colitis [64-66] followed by delayed ileo-proctostomy or proctectomy and ileo pouch construction. However, the significant clinical advantages of a laparoscopic-assisted procedure remain to be determined. When compared with open colecto-my, laparoscopic colectomy has been shown to be associated with improved postoperative pulmonary function, quicker return of bowel function, less postoperative pain, decreased postoperative length of hospital stay, positive body image and less small-bowel obstruction due to postoperative adhesions. Patients on immunosuppressive therapy are also exposed to minor risk of wound infections, incisional hernia and intra-abdominal abscesses. The main disadvantages of laparoscopic operation are steeper learning curve, longer operative time and increasing operative-room costs [67-70]. Toxic megacolon is usually excluded from laparoscopic procedure because of technical challenges in the management of the severely thinned walls of the dilated colon [68]. Emergency laparoscopic restorative coloproctecto-my is associated with higher risk of bleeding and injury of pelvic nerves. Perforated acute ulcerative colitis and abscess formation should not be operated in a laparoscopic emergency setting. Laparoscopic-assisted procedures may therefore be considered as an option for patient with fulminant colitis. At the moment, longer procedures or technically demanding operations are a reasonable alternative only in experienced hands.

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