Total Colectomy

A four or five 5/10/12-mm port method in a variable-shaped pattern, a 30° angled laparoscope and an intra-abdominal insufflation of 12 mmHg are usually used with the patient in a modified lithotomic position. If a diverting ileostomy is planned, a 10- to 12mm trocar is placed in the right lower quadrant. After abdominal exploration to assess laparoscopic feasibility, dissection is carried out in a sequential fashion from the cecum to the rectosigmoid junction a few centimetres above the anterior peritoneal reflection (Figs. 9-14). Care is taken when grasping the bowel not to injure it. The ileocolic branches, middle colic and inferior mesenteric branches are sequentially isolated and transected. Lateral colonic attachments are divided, and the omentum is dissected along with the transverse colon. The terminal ileum is transected with a linear stapler proximal to the ileocecal valve. The presacral space is not entered, and the pararectal peritoneum is not scored. The rec-tosigmoid junction is transected at the promontory with an articulated linear stapler. The entire colon is exteriorised through an enlarged right lower quadrant trocar incision overlying the rectus muscle. Finally, the terminal ileum is brought out through the same preoperatively marked site for port and stoma placement, and a standard Brooke ileostomy is constructed.

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