Laparoscopic Total Colectomy With Pouch Reconstruction

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Many children with familial polyposis (FAP) and ulcerative colitis (UC) can be medically managed into adulthood. However, some suffer from refractory disease, experience adverse disease sequelae (growth retardation and delayed puberty), or suffer treatment-related complications. For these patients, restorative proctocolectomy with ileal pouch–anal anastomosis provides an effective alternative to continued ineffective medical management. Variations of one-, two-, and three-stage procedures have been performed with good outcomes. The choice of staging the procedure is up to the discretion and experience of the surgeon. We generally perform a two-stage procedure for a healthy, nonimmunosuppressed patient with FAP and utilize a three-stage approach for the majority of patients with UC.