Typical features of Crohn's disease, such as thickened mesentery, enteric fistulae, inflammatory masses or abscesses and multiplicity of areas of intestinal involvement, have deterred many surgeons from offering laparoscopy to their patients. On the other hand Crohn's patients benefit significantly from a minimally invasive approach, since they are often malnourished and immunocompromised. They are at risk of multiple abdominal operations in their lifetime and minimal scarring and adhesion formation should be a factor in planning the surgical approach.

A 26 year old female with long standing isolated Crohn's pancolitis treated with high doses of corticosteroids, presented having eight to ten bowel movements/day. She was mildly overweight with a body mass index of 26.1. She underwent a laparoscopic total proctocolectomy with end ileostomy. This video clearly illustrates the steps of the procedure. The specimen was extracted through the perineum thus avoiding an abdominal incision.

We have performed this procedure in a total of seven patients with Crohn's pancolitis with minimal morbidity. We believe that avoiding an abdominal incision, when feasible, offers not only cosmetic advantages, but also allows for faster recovery and return to work, and significantly reduces the risk of incisional hernias and wound complications in these often debilitated patients.