Retroileal anastomosis in hand-assisted laparoscopic left colectomy: experience at a single institution

Abstract

Background

Left hemicolectomy and complicated sigmoid colectomy require an anastomosis between the transverse colon and rectum. Generous mobilization will typically allow the colon to reach to the rectum. However, despite full mobilization of the splenic flexure and extensive work on the mesentery, there are cases in which reach to the pelvis is still an issue. Retroileal routing of the colon is one technique for overcoming such a reach problem and achieving a tension-free anastomosis. Performing retroileal routing using laparoscopic techniques has been reported rarely, and to date, there are no data on this technique when performed in a hand-assisted laparoscopic fashion. This study aimed to describe the feasibility of doing a retroileal routing using a hand-assisted laparoscopic technique.

Methods

This was a retrospective chart review of patients who underwent a colon or rectal resection, either open or laparoscopic, with a pelvic anastomosis, by a single colorectal surgeon at an academic institution between 2008 and 2015 with a focus on the immediate and long-term postoperative complications, estimated blood loss, and operating room time for patients having an operation that included retroileal routing for construction of a colorectal anastomosis.

Results

A total of 340 patients fit inclusion criteria and of these, 13 underwent hand-assisted laparoscopic procedures with retroileal routing of the proximal colon to the colorectal anastomosis. Postoperative morbidity included intubation for CO2 retention in one patient and a RLL effusion in another patient; there were no anastomotic leaks. Long-term morbidities included two ventral hernias at 2 years postoperatively. Mean operating room time was 208 min. There were no 30- or 90-day mortalities.

Conclusions

Hand-assisted laparoscopic retroileal routing is a feasible and safe technique in accomplishing a tension-free colorectal anastomosis when proximal colon length makes standard routing of the colon to the rectum an issue.

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Affiliations

Authors

Contributions

Study conception and design: EKG, KAL. Acquisition of data: JJB, EKG, KAL. Analysis and interpretation of data: JJB, EKG, KAL. Drafting of manuscript: JJB, EKG, KAL. Critical revision: JJB, EKG, CYP, TJR, KAL. Approval of final version of this work: JJB, EKG, CYP, TJR, KAL. Agreement to be accountable for all aspects of the work: JJB, EKG, CYP, TJR, KAL.

Corresponding author

Correspondence to Kirk A. Ludwig.

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Disclosures

Drs. Blank, Gibson, Peterson, Ridolfi, and Ludwig have no conflicts of interest or financial ties to disclose.

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Blank, J.J., Gibson, E.K., Peterson, C.Y. et al. Retroileal anastomosis in hand-assisted laparoscopic left colectomy: experience at a single institution. Surg Endosc 34, 3408–3413 (2020). https://doi.org/10.1007/s00464-019-07116-y

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Keywords

  • Hand-assisted laparoscopic colectomy
  • Retro-ileal routing
  • Laparoscopic colon surgery
  • Left colectomy
  • Colorectal anastomosis