Laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis without diverting ileostomy for total colonic and extensive aganglionosis is safe and feasible with combined Lugol's iodine staining technique and indocyanine green fluorescence angiography

• DOI: 10.3389/fped.2022.1090336
• Publication Date: 2023-01-06T17:59:40Z
• Authors: Yoichi Nakagawa; Kazuki Yokota; Hiroo Uchida; Akinari Hinoki; Chiyoe Shirota; Takahisa Tainaka; Wataru Sumida; Satoshi Makita; Hizuru Amano; Aitaro Takimoto; Seiya Ogata; Shunya Takada; Takuya Maeda; Yousuke Gohda
• Keywords: Ileostomy; Indocyanine Green; Proctocolectomy; Endoscope

Background We present the surgical technique and outcomes of reduced-port laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis (IPACA) without diverting ileostomy for total colonic extensive aganglionosis (TCA+). Methods retrospectively reviewed TCA+ cases between 2014 2022. Preoperative was performed when transanal bowel irrigation ineffective. Radical surgery at approximately 6 kg. The using laparoscopy through a multi-channel trocar or an additional 3-mm IPACA reconstruction indocyanine green fluorescence angiography (ICG) to assess anastomotic perfusion Lugol's iodine staining visualize canal. Results Ten patients were included. Ileostomy in seven cases. median operation time blood loss 274.5 min 20 ml, respectively. No significant postoperative complications found. All experienced frequent liquid stools perianal excoriation early period, requiring anti-flatulence codeine. follow-up period 3.5 years. Three required management 1 year postoperatively, others defecated times per day. Kelly's clinical score 5 aged >4 Conclusion Reduced-port surgery, combined ICG, safe, feasible, had cosmetically clinically acceptable mid-term outcomes.