Otsuka Koki, Itabashi Tetsuya, Sasaki Akira, Kimura Toshimoto, Kato Kuniyuki, Wakabayashi Go
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
Surg Laparosc Endosc Percutan Tech. 2014 Dec;24(6):e228-32. doi: 10.1097/SLE.0b013e3182a4bfcb.
The role of laparoscopic total proctocolectomy (TPC) and ileal pouch-anal anastomosis (IPAA) for familial adenomatous polyposis (FAP) has been controversial, given its technical difficulty of selecting the appropriate distal transection line and achieving safe anastomosis. We herein describe our initial experience with the prolapsing technique for laparoscopic-assisted TPC and IPAA (J-pouch) in the treatment of FAP.
A consecutive series of patients with FAP undergoing laparoscopic-assisted TPC with IPAA were identified from a prospectively collected database between June 2004 and February 2012. Medical records were reviewed for patient demographics, operative outcomes, and follow-up.
The surgery was successfully completed in all 6 patients without any conversion to open surgery. The median operating time was 279 minutes (range, 240 to 386 min) and the median blood loss was 17.5 mL (range, 5 to 161 mL). No patient required blood transfusion. The median length of diet resumption and postoperative hospital stay were 7 days (range, 6 to 10 d) and 15 days (range, 13 to 21 d), respectively. A postoperative complication, wound infection, occurred in 1 patient. No anastomotic leakages or small bowel obstructions occurred. At a median follow-up of 59 months (range, 14.2 to 107.5 mo), no carcinoma had developed at the pouch or at the anastomotic site. Sexual function and fertility were unchanged as compared with preoperatively in 2 male patients. None of the patients experienced night-time incontinence or had to use a pad.
Our limited experience suggests that this prolapsing technique helps prevent problems with laparoscopic-assisted TPC and IPAA for FAP patients.
鉴于腹腔镜全直肠系膜切除术（TPC）和回肠储袋肛管吻合术（IPAA）在家族性腺瘤性息肉病（FAP）治疗中选择合适的远端切断线及实现安全吻合存在技术难度，其作用一直存在争议。我们在此描述我们在腹腔镜辅助TPC和IPAA（J形储袋）治疗FAP中采用脱垂技术的初步经验。
从2004年6月至2012年2月前瞻性收集的数据库中确定一系列连续接受腹腔镜辅助TPC及IPAA的FAP患者。回顾病历以获取患者人口统计学资料、手术结果及随访情况。
所有6例患者均成功完成手术，无一例转为开放手术。中位手术时间为279分钟（范围240至386分钟），中位失血量为17.5毫升（范围5至161毫升）。无患者需要输血。恢复饮食的中位时间和术后住院时间分别为7天（范围6至10天）和15天（范围13至21天）。1例患者发生术后并发症，即伤口感染。未发生吻合口漏或小肠梗阻。中位随访59个月（范围14.2至107.5个月）时，储袋或吻合口部位未发生癌变。2例男性患者的性功能和生育能力与术前相比无变化。所有患者均未出现夜间失禁或需要使用护垫。
我们有限的经验表明，这种脱垂技术有助于预防FAP患者行腹腔镜辅助TPC和IPAA时出现的问题。
