Indications

An ileocolectomy is most frequently indicated in patients with benign disease, i.e., Crohn's disease, cecal diverticulitis, intestinal tuberculosis, enteric Behcet's disease, submucosal tumors (lipoma, gastrointestinal stromal tumor, lymphoma, carcinoid, etc.), giant villous adenoma and polyps, located in the ileocecal regions. Indications are rare for performing a limited ileocecal resection for malignancies of the terminal ileum, the appendix, or the cecum. This may be the procedure of choice in palliative resection for cecal cancer.

Before the surgery for Crohn's disease, patients should have a computed tomography scan, small bowel series, and a full colonoscopy to assess the localization and dimension of any phlegmon or abscess or the presence of small bowel stricture or fistula, respectively. The pre-operative computed tomography scan is also useful to evaluate peri-ureteral inflammation and to aid in the decision to use intraoperative ureteric catheters. Preoperative enteral or parenteral nutritional support should be considered in selected patients.

Most surgeons would agree that the laparoscopic approach is con-traindicated in patients with nonlocalized intraabdominal abscesses, multiple previous bowel operations with possible dense adhesions, fixed mass with multiple fistulas, acute intestinal obstruction, and perforation.

Although the entire operation can be performed laparoscopically, most surgeons prefer a laparoscopic-assisted procedure by laparoscopic mobilization and extracorporeal resection and anastomosis.

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