BACKGROUND and AIM
Restorative proctocolectomy and ileal J-pouch-anal anastomosis is the current standard of care for reconstructive surgery in most patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The current available literature has described successful outcomes for re-operative surgery with both abdominal and perineal approaches. However, no previous series have demonstrated the feasibility of a laparoscopic assisted approach to management of various pouch-related complications. The objective was to establish the feasibility of a laparoscopic assisted approach in patients with various pouch-related complications necessitating re-operation (repair, revision or excision). 

METHODS
Patient demographics and outcomes were retrospectively collected from an IRB approved prospective database and chart review.  All procedures were performed by a single surgeon with an extensive expertise in laparoscopy and pouch-related complications. 

RESULTS
Between 2013 and 2016, 14 laparoscopic re-operative pouch procedures were performed on 11 patients (1 FAP, 10 UC) with a mean age of 41.1 and BMI of 23.6 (18-32). Nine of 11 patients had their initial pouch surgery performed laparoscopically; 1 of these 9 patients had a subsequent open pouch revision followed by an eventual laparoscopic pouch excision for recurrent pouch-vaginal fistula. The median time from the prior procedure was 1007 days (2-12562 days). Procedures included laparoscopic assisted pouch revision or repair (7/14) and laparoscopic pouch excision (7/14). Mean operative time was 273 (min 107; max 430) minutes. Two pre-emptive conversions were made in this series; one for extensive pelvic fibrosis precluding safe dissection; the other for dense intra-abdominal adhesions. Two patients developed postoperative pelvic fluid collections; 1 patient developed an intra-abdominal collection. All collections were successfully drained through percutaneous imaging techniques. Median length of stay was 9.5 (3-24 days). 

CONCLUSION
Despite longer operative times, our series demonstrates the feasibility of a laparoscopic assisted approach for re-operative pouch surgery in centers who practice high-volume minimally invasive and pouch related surgery.

The Feasibility of a Laparoscopic Approach to Re-operative Ileoanal J-pouch Surgery