Minimally invasive total proctocolectomy with Brooke ileostomy for ulcerative colitis

BACKGROUND: Total proctocolectomy with Brooke ileostomy remains the optimal surgical procedure for select ulcerative colitis patients. However, few studies describe outcomes of minimally invasive total proctocolectomy with Brooke ileostomy. Our aim was to describe the safety and feasibility of these procedures by examining short-term (30-day) outcomes. METHODS: Using a prospective database, we identified a cohort of patients who underwent laparoscopic total proctocolectomy with Brooke ileostomy at our institution from 2000-2007. Results are reported as median (range) or frequency (proportion). RESULTS: Forty-four patients were included; age 65 years (54-73), 24 were male (55%), body mass index was 26.5 (22.1-30.2) kg/m(2). Colitis duration was 66 months (24-240), and 40% had prior surgery. The indication for surgery was refractory colitis (82%) and neoplasia (18%). Factors influencing choice of total proctocolectomy with permanent ileostomy were advanced age in 18 (41%), lifestyle in 13 (30%), medical comorbidities in 11 (25%), fecal incontinence in 10 (23%), oncologic reasons in 3 (6.8%), and obesity in 3 (6.8%). Twenty-three (52%) operations were hand-assisted laparoscopic surgery, 13 (30%) were laparoscopic-assisted, and 8 (18%) were "laparoscopic-incisionless" with transanal specimen extraction. Two laparoscopic-assisted cases (4.6%) were converted. Operative time was 329 (272-402) minutes, and length of stay 5 (4-6) days. Major post-operative complications occurred in 4 (9%); there were no perioperative mortalities. CONCLUSIONS: Minimally invasive total proctocolectomy with Brooke ileostomy is a safe, feasible option for the surgical treatment of chronic ulcerative colitis, and is the procedure of choice for select patients.