Laparoscopic or Robotic Ileoanal Pouch Procedure
UW Health surgeons at UW Hospital and Clinics perform laparoscopic and robotic ileal pouch reconstruction, also called a restorative proctocolectomy, to allow patients with conditions such as ulcerative colitis, familial polyposis, and certain types of colon cancer to avoid living with a permanent ileostomy after colectomy.
This minimally invasive approach removes the diseased colon and rectum and then restores the bowel control of the patient by refashioning the small bowel into a pouch and attaching it to the anal canal. This technique gives approximately 95 percent of patients near-perfect continence during the day and 90 percent good to excellent continence at night.
The traditional open approach leaves patients with a large incision extending from above the umbilicus to the top of the pubic bone. Laparoscopic and robotic approaches are preferred by our surgeons as research indicates better short-term outcomes in patients who undergo this minimally invasive operation.
First, the surgeon removes the diseased colon and rectum. Next, they mobilize the small bowel's blood supply and mesentery (membranous tissue attaching the ileum to the body wall) to determine whether the ileum will reach the anal canal.
For most patients, the small bowel will extend the necessary length; otherwise the surgeon will employ a variety of techniques to make the ileum reach the anal canal. The pouch is created using the design most appropriate for the patient, whether it be a J-reservoir or a S-reservoir. In the unusual event that the small bowel does not reach, they may have to create a permanent end ileostomy.
After construction of the pouch, the reservoir outlet is sutured or stapled to the anal canal, and a temporary loop ileostomy is placed to protect the low anastomosis and allow the newly created pouch to heal. The temporary ileostomy is usually positioned slightly below and to the right or left of the navel. The enterostomal therapy nurse will work with the patient before the procedure to determine the best place for the ileostomy.
After approximately two months, the patient will return for ileostomy takedown after confirming with a contrasted enema study in radiology that the pouch has healed appropriately. The surgeon will then takedown the ileostomy, allowing the pouch to begin functioning on its own. Following the ileostomy takedown, normal ileal pouch function and bowel movements will begin. The patient will have a small scar where the ileostomy used to be.
The Difference of Minimally Invasive
There are numerous benefits to having this procedure performed laparoscopically or robotically rather than with the traditional open method:
- Faster recovery
- Shorter hospital stay
- Less pain post-operatively
- Fewer post-operative complications
- Cosmetic appeal - Rather than one long incision across the abdomen, small, barely visible incisions are placed in the abdomen