VIDEO VIGNETTE
Laparoscopic Total Colectomy With Brooke Ileostomy for Chronic Ulcerative Colitis After Orthotopic Liver Transplantation for Primary Sclerosing Cholangitis Stefan D. Holubar, M.D., M.S. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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everal case reports describe hand-assisted laparoscopic colectomy for chronic ulcerative colitis after prior orthotopic liver transplantation (OTL) for primary sclerosing cholangitis. However, to the best of our knowledge, there are no cases describing a straight laparoscopic approach to total colectomy after liver transplant. In this video, we present a 42-year-old man who had undergone OTL for primary sclerosing cholangitis in 2011 (see Video, S upplemental Digital Content 1, http://links. lww.com/DCR/A136). He presented to colorectal surgery with chronic ulcerative colitis refractory to tacrolimus, azathioprine, and infliximab; his BMI was 31 kg/m2. The OTL operative note indicated that he had undergone a retrocolic Roux-en-Y limb reconstruction 20 cm distal to the ligament of Treitz, with hepatic artery reconstruction, via a chevron incision. Given the severe disease and triple immunosuppressive therapy, the decision was made to proceed with a 3-stage approach to restorative proctocolectomy. Institutional review board approval and patient consent were obtained.
Key operative steps included adhesiolysis; remobilization of terminal ileum, cecum, and right colon and hepatic flexure; identification of the Roux limb; and remobilization of transverse colon proximal and distal to the Roux limb. Given a bulky, friable colon, to avoid the specimen rupturing during ileostomy site extraction attempts, after the resection was completed, the specimen was delivered intact via a
Laparoscopic Total Colectomy With Brooke Ileostomy for Chronic Ulcerative Colitis After Orthotopic Liver Transplantation for Primary Sclerosing Cholangitis Stefan D. Holubar, M.D., M.S. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
S
everal case reports describe hand-assisted laparoscopic colectomy for chronic ulcerative colitis after prior orthotopic liver transplantation (OTL) for primary sclerosing cholangitis. However, to the best of our knowledge, there are no cases describing a straight laparoscopic approach to total colectomy after liver transplant. In this video, we present a 42-year-old man who had undergone OTL for primary sclerosing cholangitis in 2011 (see Video, S upplemental Digital Content 1, http://links. lww.com/DCR/A136). He presented to colorectal surgery with chronic ulcerative colitis refractory to tacrolimus, azathioprine, and infliximab; his BMI was 31 kg/m2. The OTL operative note indicated that he had undergone a retrocolic Roux-en-Y limb reconstruction 20 cm distal to the ligament of Treitz, with hepatic artery reconstruction, via a chevron incision. Given the severe disease and triple immunosuppressive therapy, the decision was made to proceed with a 3-stage approach to restorative proctocolectomy. Institutional review board approval and patient consent were obtained.
Key operative steps included adhesiolysis; remobilization of terminal ileum, cecum, and right colon and hepatic flexure; identification of the Roux limb; and remobilization of transverse colon proximal and distal to the Roux limb. Given a bulky, friable colon, to avoid the specimen rupturing during ileostomy site extraction attempts, after the resection was completed, the specimen was delivered intact via a
