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. 2023 Jan 6:10:1090336.
doi: 10.3389/fped.2022.1090336. eCollection 2022.

Laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis without diverting ileostomy for total colonic and extensive aganglionosis is safe and feasible with combined Lugol's iodine staining technique and indocyanine green fluorescence angiography

Yoichi Nakagawa  1 , Kazuki Yokota  2 , Hiroo Uchida  1 , Akinari Hinoki  3 , Chiyoe Shirota  1 , Takahisa Tainaka  1 , Wataru Sumida  1 , Satoshi Makita  1 , Hizuru Amano  1 , Aitaro Takimoto  1 , Seiya Ogata  1 , Shunya Takada  1 , Takuya Maeda  1 , Yousuke Gohda  1
Affiliations

Laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis without diverting ileostomy for total colonic and extensive aganglionosis is safe and feasible with combined Lugol's iodine staining technique and indocyanine green fluorescence angiography

Yoichi Nakagawa et al. Front Pediatr. .

Abstract

Background: We present the surgical technique and outcomes of reduced-port laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis (IPACA) without diverting ileostomy for total colonic and extensive aganglionosis (TCA+).

Methods: We retrospectively reviewed TCA+ cases between 2014 and 2022. Preoperative ileostomy was performed when transanal bowel irrigation was ineffective. Radical surgery for TCA+ was performed at approximately 6 kg. The surgery was performed using laparoscopy through a multi-channel trocar with or without an additional 3-mm trocar and IPACA reconstruction with indocyanine green fluorescence angiography (ICG) to assess anastomotic perfusion and Lugol's iodine staining to visualize the surgical anal canal.

Results: Ten patients with TCA+ were included. Ileostomy was performed in seven cases. The median operation time and blood loss were 274.5 min and 20 ml, respectively. No significant postoperative complications were found. All patients experienced frequent liquid stools and perianal excoriation in the early postoperative period, requiring anti-flatulence or codeine. The median follow-up period was 3.5 years. Three patients required irrigation management 1 year postoperatively, and the others defecated a median of 3.5 times per day. The median Kelly's clinical score was 5 in 5 patients aged >4 years.

Conclusion: Reduced-port surgery, combined with Lugol's iodine staining and ICG, was safe, feasible, and had cosmetically and clinically acceptable mid-term outcomes.

Keywords: diverting ileostomy; extensive aganglionosis; j pouch; laparoscopic restorative proctocolectomy; minimally invasive surgery; total colonic aganglionosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) the surgeon stood adjacent to the patient's head, and the surgical and camera assistants were positioned on the right and foot side of the patient until the transanal procedure. The surgeon was positioned at the foot side of the patient during the transanal procedure. (B) A spindle-shaped incision around the stoma or Benz incision at the umbilicus was made in patients with or without enterostomy, respectively. An additional 3-mm trocar was placed if required. (C) The wound 1 month postoperatively is healing correctly and is not so visible.
Figure 2
Figure 2
When pulling the J-pouch through the anal canal, it was mobilized by dissecting the mesenchyme after confirming adequate retention for perfusion by indocyanine green fluorescence angiography with a vessel clamp. Indocyanine green was intravenously injected with a dose of 0.01 mg/kg.
Figure 3
Figure 3
Lugol's iodine staining shows a well-demarcated line indicated by arrowheads (herrmann line). This line allows easy identification of the incision line.
Figure 4
Figure 4
(A) Indocyanine green fluorescence angiography was performed to assess the anastomotic perfusion (pre-injection). (B) ICG at a dose of 0.01 mg/kg was intravenously injected. (C) After confirming the J-pouch with good fluorescence, ileal-J-pouch anal canal anastomosis was constructed.
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References

    1. Laughlin DM, Friedmacher F, Puri P. Total colonic aganglionosis: a systematic review and meta-analysis of long-term clinical outcome. Pediatr Surg Int. (2012) 28:773–9. 10.1007/s00383-012-3117-3. - DOI - PubMed
    1. Amano H, Uchida H, Kawashima H, Deie K, Murase N, Makita S, et al. The umbilical benz incision for reduced port surgery in pediatric patients. JSLS. (2015) 19:e2014.00238. 10.4293/JSLS.2014.00238. - DOI - PMC - PubMed
    1. Yokota K, Amano H, Kudo T, Yamamura T, Tanaka Y, Tainaka T, et al. A novel Lugol's Iodine staining technique to visualize the upper margin of the surgical anal canal intraoperatively for hirschsprung disease: a case series. BMC Surg. (2020) 20:317. 10.1186/s12893-020-00986-3 - DOI - PMC - PubMed
    1. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. (2004) 240:205–13. 10.1097/01.sla.0000133083.54934.ae. - DOI - PMC - PubMed
    1. Ieiri S, Suita S, Nakatsuji T, Akiyoshi J, Taguchi T. Total colonic aganglionosis with or without small bowel involvement: a 30-year retrospective nationwide survey in Japan. J Pediatr Surg. (2008) 43:2226–30. 10.1016/j.jpedsurg.2008.08.049. - DOI - PubMed

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