TPC with IPAA is beneficial because there is removal of the entire colon and rectum, but there is increased stool frequency (6-8 BMs/day), risk of defecation and genitourinary dysfunction, and decreased fertility in women. Major fecal incontinence occurs in less than 5% of IPAA patients during the day and 12% during sleep. The TPC with IPAA procedure is typically performed in two or three stages with a temporary loop ileostomy and an eventual ileo-anal J pouch. Older, high-risk patients, those with poor sphincter function, and patients with cancer in the distal rectum can undergo a one-stage procedure (TPC) with a permanent end ileostomy to avoid continence issues. However, these patients may struggle with frequent fluid shifts and dehydration associated with high-ileostomy output.
When performing total proctocolectomy with IPAA, correctly position the patient, drape the operative area, and place the equipment, without prompting from the surgical attending.
When performing total proctocolectomy with IPAA, secure and divide the blood supply of the abdominal colon without undue prompting or assistance.
When performing total proctocolectomy with IPAA, correctly perform pelvic dissection with minimal injury to autonomic nerves.
When performing total proctocolectomy with IPAA, perform and evaluate extracorporeal J-pouch construction and anal anastomosis, both stapled and hand-sewn, to create a tension-free anastomosis and understand alternative reconstructions to the J pouch.
Given a patient undergoing laparoscopic total proctocolectomy with IPAA, independently identify those circumstances that dictate conversion to an open procedure.
Given a patient undergoing total proctocolectomy with IPAA, independently identify those circumstances that dictate temporary diversion.
When mobilizing the ileum for J-pouch construction, perform specific-lengthening maneuvers to allow for a tension-free, ileo-anal anastomosis.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
