The indications for a laparoscopic proctocolectomy with ileoanal pouch construction are the same whether the procedure is performed by a conventional or laparoscopic approach. Nearly all patients will undergo this operation either for ulcerative colitis refractory to medical therapy or familial adenomatous polyposis. Unless the patient has had multiple prior abdominal surgeries, or known intraabdominal adhesions, the procedure can likely be performed laparoscopically. The surgeon must be skilled in laparoscopic segmental resection and should be experienced in performing a laparoscopic total colectomy before attempting this complex procedure. Because of potential friability of the colon in ulcerative colitis, a surgeon should not perform laparoscopic total col-ectomy for acute colitis until they are quite comfortable with laparo-scopic total colectomy in a noninflamed colon. Obesity (body mass index >30 kg/m2), was previously considered a contraindication to a laparoscopic total colectomy. However, once the surgeon has performed the procedure in thinner patients, it may be attempted in a more obese population. I do not believe obesity is a contraindication to laparos-copy, but rather I believe this should be a preferred approach to the procedure because it minimizes the potential for significant wound complications.

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