Giudici Francesco, Scaringi Stefano, Di Martino Carmela, Ficari Ferdinando, Bechi Paolo
Department of Surgery and Translational Medicine, Surgical Unit, University of Florence, Florence, Italy.
J Minim Access Surg. 2017 Jul-Sep;13(3):188-191. doi: 10.4103/0972-9941.199607.
No previous study clearly focuses on laparoscopic technique to perform the second stage surgery (proctectomy with ileal pouch-anal anastomosis [IPAA]) after total colectomy for acute/severe ulcerative colitis (UC). We describe the procedural steps for a simple and rational minimally invasive second stage surgery, reporting intra- and short-term post-operative results.
During the period December 2014-December 2015, 10 consecutive patients (8 males and 2 females) with mean age of 48 years underwent laparoscopic proctectomy and IPAA adopting our novel approach. They were operated 3 months after the previous total colectomy which has been performed, respectively, for acute (three patients) or severe (seven patients) UC. Intraoperative data and post-operative complications, divided as minor and major, were recorded and analysed. A body image questionnaire was administered to all patients to evaluate the cosmetic results of the procedure.
Overall mean surgical time was 235 ± 49 min. During the post-operative course, three patients required morphine for >48 h, no patient needed blood transfusion and bowel movements recovery happened as mean during the 2nd day. No early major complications happened. Two patients (20%) developed peri-ileostomic wound infection at the right flank. Only one patient (10%) suffered from ileal-anal anastomotic dehiscence, conservatively treated till resolution. The average length of hospital stay was 8 ± 2 days. The body image questionnaire showed in all patients an extreme satisfaction about the results obtained (mean value = 59/64 points).
Through three standardised surgical steps easily reproducible, we describe an almost scar-less procedure able to optimise the intraoperative time with good post-operative results in terms of complications and cosmesis.
既往尚无研究明确聚焦于腹腔镜技术用于急性/重度溃疡性结肠炎（UC）全结肠切除术后的二期手术（直肠切除术加回肠储袋肛管吻合术[IPAA]）。我们描述了一种简单且合理的微创二期手术的操作步骤，并报告术中及短期术后结果。
在2014年12月至2015年12月期间，10例连续患者（8例男性和2例女性），平均年龄48岁，采用我们的新方法接受了腹腔镜直肠切除术和IPAA。他们在上次全结肠切除术后3个月接受手术，上次全结肠切除术分别因急性（3例患者）或重度（7例患者）UC而进行。记录并分析术中数据以及分为轻微和严重的术后并发症。对所有患者进行了身体形象问卷调查，以评估该手术的美容效果。
总体平均手术时间为235±49分钟。在术后过程中，3例患者需要使用吗啡超过48小时，无患者需要输血，平均在术后第2天恢复排便。未发生早期严重并发症。2例患者（20%）在右侧腹出现回肠造口周围伤口感染。仅1例患者（10%）发生回肠肛管吻合口裂开，经保守治疗直至愈合。平均住院时间为8±2天。身体形象问卷调查显示所有患者对所获得的结果极为满意（平均值=59/64分）。
通过三个易于重复的标准化手术步骤，我们描述了一种几乎无瘢痕的手术方法，该方法能够优化术中时间，在并发症和美容方面取得良好的术后效果。
