Abstract
We report the case of a 19-year-old woman of familial adenomatous polyposis treated by one-stage restorative proctocolectomy with ileal J pouch anal anastomosis with the bikini line skin incision approach (BIAA) using laparoscopy. After a 10-cm curved transverse skin incision under the bikini-line, a flap was developed on the rectus sheath to the level of the umbilicus. Then longitudinal minilaparotomy was completed. RPC with IAA was completed with direct visualization of the operative field by a small retractor and gauze packing of the small intestine. Visualisation of hepatic and splenic flexure was difficult because they are located high up. We used a laparoscope inserted directly from the wound and got a better view which enabled us to perform the procedure more safely and easily. The duration of surgery was 262 minutes and blood loss was only 60 ml. Time to start oral intake was 2 days and postoperative hospitalization was 11 days. BIAA has cosmetic merit and is useful for young female patients. Laparoscopy is suggested to be useful in conducting BIAA more safely and easily especially when managing a difficult case in which hepatic or splenic flexure would be located high up.
