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Restorative proctocolectomy with ileal pouch-anal anastomosis: Laparoscopic approach

Alessandro Fichera, MD, FACS, FASCRS
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


A total proctocolectomy (TPC) is the surgical treatment option for patients who have failed medical management for ulcerative colitis, select patients with Crohn's disease (without evidence of anorectal disease), and patients with hereditary nonpolyposis colorectal cancer or synchronous colon cancers. In addition, because of an associated increased risk of colon cancer development, a total proctocolectomy is offered as prophylaxis to patients diagnosed with familial adenomatous polyposis (picture 1).

The development of the continence-preserving procedure, restorative proctocolectomy and ileal pouch-anal anastomosis (RPC-IPAA), has made surgical management a more attractive option than a TPC with a permanent end ileostomy. Both approaches can improve the quality of life and reduce the risk of colonic malignancy, and both can be performed as an open or laparoscopic procedure [1,2]. Optimal results depend upon surgical expertise, the clinical setting, and patient selection.

This topic will describe technical details of a laparoscopic approach to the restorative proctocolectomy with ileal pouch-anal anastomosis.


A restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) removes the entire colon and rectum while preserving the anal sphincter and, hence, normal bowel function and fecal continence [3-6].The pouch serves as an internal pelvic reservoir for intestinal contents.

The optimal laparoscopic approach has not been established. A few variations of the procedure have been described that include hand-assisted and laparoscopically assisted techniques, a single-incision laparoscopic technique, and variations in construction of the ileal pouch [6-9].

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Literature review current through: Nov 2017. | This topic last updated: May 30, 2017.
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