Robotic completion proctectomy and IPAA after urgent colectomy for ulcerative colitis: pouch construction through the previous ileostomy site
David Julià-Bergkvist, Nuria Gomez-Romeu, Olga Delisau, Eloi Maldonado, Maria Jose Gomez-Jurado, Anna Pigem, Pere Planellas, David Busquets, Judith Luquin, Paula Creus, Frank Fernandez, David Sambrano, Bernat Montane, Marc Fonollosa, Lara Coll, Claudia Vila, Lluis Agostini, Ramon FarresAbstract
Introduction
Robotic completion proctectomy with IPAA using the previous ileostomy site for extracorporeal pouch construction and robotic access may be a feasible option in staged ulcerative colitis surgery.
Methods
From 2018 to 2024, 11 patients underwent second-stage restorative surgery after urgenttotal colectomy with terminal ileostomy and sigmoid mucous fistula for ulcerative colitis (UC).Procedures were robotic in 8 cases, laparoscopic in 1, and open in 2. In robotic cases, the ileostomy was first taken down and standard-ilealJ-pouch was fashioned through the previous ileostomy incision.This incision was used as a robotic access site.The sigmoid mucous fistula was taken down, and its site was used for the left-sided robotic port. Specimen extraction was performed through the previous mucous-fistula-site.Robotic completion proctectomy was then performed using a modified low anterior resection technique, followed by IPAA and diverting loop ileostomy (video). In 3 cases, mobilization of the mesenteric root up to the duodenum was required to achieve adequate-pouch-reach.
Results
There were 7 men and 4 women,mean age 41 years mean operative time 270 min. Among robotic cases, the index colectomy had been performed laparoscopically in 7 patients and open in 1.Major postoperative complications included 1 small bowel perforation requiring reoperation(Clavien-Dindo IIIb) and 1 persistent postoperative ileus(Clavien-Dindo II).During long-term-follow-up of 15 m–5 years,1 patient developed severe pouchitis with pouch-vaginal fistulas requiring pouch resection,and another required biologic therapy for pouchitis.
Discussion
Robotic completion proctectomy with IPAA after urgent colectomy for UC is feasible and allows effective use of the previous ileostomy site for pouch construction and robotic access, potentially limiting additional abdominal wall trauma.