Laparoscopic proctocolectomy and ileal pouch-anal anastomosis (IPAA) is a safe alternative to performing a laparotomy with reduced hospital stay, post-operative pain and earlier return of gastro-intestinal function. An abdominal incision is still required for specimen extraction and pouch formation. We demonstrate the feasibility of performing the surgery entirely laparoscopically.

A 37 year old woman with pan-colitis who had failed medical therapy presented for IPAA. A totally laparoscopic approach was planned.

The entire colon and rectum were mobilized laparoscopically using 1 x10mm,2 x 5mm and 1 x 12mm trocars and the rectum divided at the level of the pelvic floor. The rectal and colonic mesentery were divided intra-corporeally and the specimen extracted via the right lower terminal ileum was transected, a J pouch created via the same site, and returned to the abdomen. The pneumoperitoneum was re-established and the pouch-anal anastomosis created. A standard loop ileostomy was created. The patient had no other incisions, made an excellent recovery and was discharged on post-operative day 4.

Totally laparoscopic IPAA is a safe procedure which may further reduce the incidence of post operative complications.