At present, the standard surgical treatment for ulcerative colitis is total colectomy + ileal pouch-anal anastomosis (IPAA), which completely removes the target organ of colorectal lesion, and at the same time, ensures the function of anal self-control because the anal sphincter is completely preserved, taking into account the curability of the disease and the quality of life of the patient. However, not many surgeons in the field of surgery in China can complete the operation of ileal storage pouch-anal tube anastomosis (IPAA) (Cui Long, Chinese Journal of Gastrointestinal Surgery, 2013(16)4:319-322), and even fewer surgeons and units can complete total colectomy + IPAA independently under laparoscopy. Li Yuanxin, Department of General Surgery, 309th PLA Hospital, traditional open total colectomy surgery is very traumatic because it requires simultaneous surgery of three parts: rectum, left hemicolectomy, and right hemicolectomy, from top to bottom and from left to right, so the incision of traditional open surgery is large, usually in the abdomen, about 20-30 cm long, and the surgery is Therefore, the traditional open surgery incision is large, usually in the abdomen, about 20-30 cm long, with a wide range, great trauma, slow recovery and many complications, which has been a huge invasive surgery for doctors and patients. Laparoscopic total colectomy technology has many advantages of minimally invasive surgery, such as precise surgery, small trauma, less blood loss, fast recovery and less pain, especially it can avoid pelvic nerve injury and anal sphincter injury, which has the advantage that traditional open surgery cannot be compared. Laparoscopic total colectomy involves a wide area, a large span, and a large number of vessels that need to be ligated from the root, and in addition to the entire colon and terminal ileum, the resection also includes all or most of the rectum. The surgical operation includes all four quadrants of the abdomen, which is equivalent to completing laparoscopic ultra-low rectal cancer radical surgery, laparoscopic left hemicolectomy, laparoscopic right hemicolectomy, plus ileal storage pouch formation at the same time, making the operation difficult and long. It is a difficult and complicated laparoscopic gastrointestinal surgery. During the surgery, it is also necessary to change the position of the operator, assistant and mirror holder and the patient’s body position, and to change the position of the main operation hole and monitor. Laparoscopic total colectomy + ileal storage pouch-anal tube anastomosis (IPAA) has very high technical requirements. The technical requirements for laparoscopic separation of colon and rectum are the same as those for standardized radical surgery for ultra-low rectal cancer, radical surgery for left hemicolectomy, and radical surgery for right hemicolectomy. When laparoscopic total colectomy is performed to separate the colon, rectum and its mesentery, it is required to be performed strictly in a series of tissue gaps such as Toldt and posterior rectum, which can avoid damaging the pelvic nerves and have less impact on postoperative anal defecation function and sexual function, and can achieve micro blood loss surgery; the surgery also requires ligating the blood vessels supplying each segment of the colon from the root, the significance of which is different from the above radical surgery for colon and rectal cancer and is not It is not for the purpose of lymph node dissection, but to avoid the tediousness of dealing with multiple vessels branching from the colonic mesentery in the process of freeing it, to simplify the operation and to prevent bleeding from entering the colon or rectal mesentery to interfere with the operation process; when dealing with the lower rectal segment, the puborectalis muscle should be exposed before nudging the rectal canal wall, which requires high technical requirements and highlights the great advantages of laparoscopic precision surgery. In traditional open surgery, when separating the ultra-low rectum, the operator usually cannot observe the field with the naked eye and can only do so by the operator’s hand, which is often prone to damage the pelvic nerves, and either the separation is too low and damages the internal anal sphincter and thus affects the anal defecation function, or the separation of the lower rectum is insufficient, resulting in insufficient resection; for patients with short ileal mesentery, forcibly pulling down the ileal storage pouch and anastomosing with the anal canal will result in For patients with short ileal mesentery, forcibly pulling down the ileal storage bag and anastomosis with the anal canal will lead to large anastomotic tension, which is also the main cause of postoperative anastomotic fistula and chronic ischemic stenosis of the anastomosis. The ileal pouch-anal anastomosis (IPAA) was reported in 1978 by Parks et al. The main steps are total colectomy, rectal mucosal debridement, preservation of the anal sphincter, transformation of the terminal ileum into a storage pouch and reconstruction of the rectum. The ileal storage pouch anastomosis within the rectal muscle sheath is also performed. The techniques of this procedure include: (1) the design of the storage pouch: the function of the storage pouch mainly depends on the compliance of the ileum, the perfect function of the anal sphincter and the complete anal nerve reflex, the J-shaped storage pouch is the commonly used form of the storage pouch, the design of the storage pouch is the key to the recovery of the patient’s postoperative fecal function, the key to the design of the storage pouch is the way of anastomosis and the height of the storage pouch; (2) transanal mucosal resection with ileal storage pouch-anal tube anastomosis technique. With the development of surgical anastomosis technology, the current international mainstream technique uses double anastomosis technique to complete ileal pouch-anal canal anastomosis, and studies have shown that anastomosis has better functional outcome than manual anastomosis, although the main disadvantage of anastomosis is the risk of future inflammation (rectal stump capitis) in the remaining 1.5-2.0 cm of rectal mucosa, but usually responds well to local medication. (Ingrid Ordas, et al. Ulcerative colitis. Lancet 2012; 380: 1606-19) A protective ileostomy strategy after ileal storage pouch-anal canal anastomosis (IPAA) is very sensible. Protective ileostomy can reduce the risk of anastomotic leak in ileal pouch-anal anastomosis (IPAA) and avoid serious complications such as abdominal infection due to anastomotic leak; it can lead to a normal diet as early as possible after surgery; due to the lack of physiological function of the colorectum to absorb water and the impact on the function of the anal sphincter in the early stage of anal anastomosis, the absence of a protective ostomy can lead to severe diarrhea and affect the function of the anus Recovery. With a protective ileostomy, the ileal fluid can become thicker and the anal function can be restored in a few months of compensation, and the patient can heal quickly, safely and with a high quality of life by performing a minor operation like stoma rejection. Compared with other laparoscopic total colectomy operations, laparoscopic total colectomy operations for ulcerative colitis are more difficult because, first, ulcerative colitis lesions lead to brittle colonic tissues and easy bleeding during separation; second, ulcerative colitis has a long disease duration and recurrent chronic inflammation leads to heavy intra-abdominal adhesions and disappearance of normal anatomical gaps, which enhances the difficulty of separation; third, colorectal mesentery of ulcerative colitis patients is generally thickened and increased. Third, the colorectal mesentery of patients with ulcerative colitis is generally thickened and thickened, which increases the difficulty of rectal resection and nakedness of the intestinal canal. We have recently completed this patient with a history of ulcerative colitis of nearly 30 years, long-term drug treatment, the three aforementioned difficulties in laparoscopic surgery, and complete obstruction of the colon in many places, resulting in the ileum showing obstruction, ileal intestinal canal dilatation, edema, and a large amount of digestive fluid accumulation, which is a relative contraindication to laparoscopic surgery, greatly increasing the difficulty of laparoscopic surgery. The successful completion of laparoscopic total colectomy + IPAA in this patient with poor surgical conditions, together with the fact that we have routinely performed laparoscopic subtotal colectomy (Jinling’s operation), total laparoscopic extra-abdominal perineal colectomy (ELAPR) via the anal raphe and various radical resections for colon and rectal cancer, indicates that our colorectal laparoscopic level has reached the advanced level in China. The indications for laparoscopic total colectomy + IPAA are: (1) severe ulcerative colitis or ulcerative colitis with cancer that has failed to be treated by internal medicine (see Dr. Li Yuanxin’s article on this website – Medical Science “Minimally Invasive Laparoscopic Surgery for Ulcerative Colitis”); (2) familial polyposis (see Dr. Li Yuanxin’s article on this website – Medical Science (2) Familial polyposis (see Dr. Li Yuanxin’s article “Can familial adenomatous polyposis become cancerous? Can laparoscopic minimally invasive surgery be performed?) (3) extensive colonic diverticula producing recurrent infections; (4) multiple colon cancer. Laparoscopic total colectomy + IPAA is our routine surgical modality for the treatment of the above diseases. Figure 1 Surgical model: A: total colectomy; B: ileal pouch-anal anastomosis (IPAA) with protective ileostomy; C: ileostomy rejection after several months Figure 2 ileal pouch-anal anastomosis Figure 3 ileal pouch formation Figure 4 traditional total colectomy, the surgical incision is “on top of the abdomen”, about 30~1000cm long 1000cm Figure 5 Laparoscopic total colectomy, with only a 6cm surgical incision in the abdomen, the whole colon is removed laparoscopically and ileal pouchplasty is performed through this incision Figure 6 Ileal pouchplasty Figure 7 Removal of the whole colon + rectum specimen. In this case, the patient had ulcerative colitis for nearly 30 years, and long-term medication treatment resulted in complete obstruction of the colon in many places, resulting in an obstructed ileum with dilated and edematous intestinal canal and large accumulation of digestive fluid, which greatly increased the difficulty of laparoscopic surgery