Michael R. Marohn, Eric J. Hanly, Kevin J. McKenna, Carmen R. Varin, Johns Hopkins University, Baltimore, MD

Objective: We report results from a single surgeons ten-year team experience with laparoscopic total abdominal colectomy. Previous reports of laparoscopic total colectomy have been mixed. We review our series, which includes a large subgroup of ill, high risk patients, requiring urgent surgery.

Methods: From 1993 to 2003, our group performed 65 laparoscopic total abdominal colectomies. All patients referred for total abdominal colectomy were offered a laparoscopic approach. We tracked patient demographics, surgical indications, preoperative status, duration of surgery, blood loss, complications, length of stay, subsequent surgeries, patient satisfaction, and lessons learned from our experience.

Results: Preoperative diagnoses included ulcerative colitis (85%), Crohns colitis (5%), colonic inertia (5%), and familial adenomatous polyposis (FAP) (5%). Among the inflammatory bowel disease patients, 70% of cases were performed on ill patients, refractory to medical management, requiring urgent surgery. This subgroup was managed with laparoscopic total abdominal colectomy and Brooke ileostomy, with ileo-anal pouch anastomosis deferred. Operative times were long, ranging from 6 to 9+ hours. Blood loss averaged ~200 cc. Length of stay ranged from 2 to 13 days, averaging 4.3 days. There were no conversions to open surgery and there were no deaths. Complications occurred in 12% of patients and included intra-abdominal abscess (2), wound infection (3), stoma stenosis (1), and incisional hernia (2). Postoperative patient satisfaction was high. Subsequent surgeries, including restorative proctectomy, were also performed laparoscopically.

Conclusions: Laparoscopic total abdominal colectomy is technically challenging and requires a team approach, but offers patients significant benefit in length of stay and surgical recovery, and can be effectively employed with minimal morbidity in difficult, ill patients requiring urgent surgery.