To investigate the causes, prevention and treatment strategies of complications in laparoscopic proctocolectomy ileal j-pouch anal anastomosis(IPAA).

The clinical data of 42 patients with familial adenomatous polyposis and ulcerative colitis who underwent laparoscopic proctocolectomy IPAA in Nanfang Hospital of Southern Medical University from April 2014 to May 2022 were retrospectively analyzed, and the causes of postopera-tive complications and management measures were analyzed.

All 42 patients, including 25 cases of FAP and 17 cases of UC, underwent laparoscopic surgery. The median blood loss was 50 mL(10~500 mL) and the median operation time was 306 min (203~487 min). The anastomosis method was ileal j-pouch anal anastomosis. The incidence of postoperative complications was 23.8%, among which the incidence of ileal j-pouch bleeding was 14.3%, all of which were cured by endoscopic hemostasis. The incidence of adhesive intestinal obstruction and gastroparesis syndrome was 7.1% and 4.8%, respectively. Gastrointestinal function recovered after conservative treatment with fasting, gastrointestinal decompression and parenteral nutrition support. The incidence of intra-abdominal hemorrhage was 2.4%, which was cured by conservative treatment. Multivariate Logistic regression analysis showed that intraoperative blood loss >100 mL (OR=9.896, 95%CI: 1.206~81.214, P=0.033) was an independent risk factor for complication laparoscopic proctocolectomy IPAA.

Reliable hemostasis, complete hemostasis and repeated examination before laparoscopic proctocolectomy IPAA should be achieved. After the preparation of the ileal j-pouch, the routine whole-layer reinforcement suture after the preparation of ileal j-pouch and colonoscopy after ileal j-pouch anal anastomosis will be conducive to the early detection of the bleeding of the anastomosis and the ileal j-pouch and the timely and effective hemostasis.