Laparoscopic Total Proctocolectomy for Familial Adenomatous Polyposis with Lower Rectal Adenocarcinoma
The current video demonstrates the procedure of total proctocolectomy with an end-ileostomy in a 32-year-old patient with familial adenomatous polyposis accompanied by early-stage lower rectal cancer. The laparoscopic approach was preferred for complete mesocolic and total mesorectal excisions. Perineal resection was performed to fulfill total proctocolectomy.
The patient was hospitalized a day before the surgery. A clear liquid diet, laxative, and fleet enema were given for the bowel preparation. The patient wore compression stockings.
Prophylactic antibiotics were administered half an hour before surgery. Under general anesthesia, the patient was placed in lithotomy-Trendelenburg position at the beginning, and the position was continuously modified according to the dissected colon segment during the procedure. Six trocars were inserted to access all quadrants of the abdomen.
High ligation of the arteries and the maintenance of the dissection up to the pancreatic level are the critical points of the procedure. Because the malignant potential for each polyp cannot be estimated preoperatively, oncologic principles should be implemented in every step. In addition, sticking to the embryologic planes serves as a roadmap and helps to avoid bleeding or any injury.
Potential areas for injury can be the duodenum and superior mesenteric artery for the right colon and the ureters for both sides.