• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Laparoscopic Low Anterior Resection with en bloc Small Bowel Resection and Difficult Takedown of the Splenic Flexure

Laparoscopic Low Anterior Resection with en bloc Small Bowel Resection and Difficult Takedown of the Splenic Flexure

Deborah S Keller, MD, Justin K Lawrence, MD, Conor P Delaney, MD, MCh, PhD

University Hospital- Case Medical Center

This 65 year-old man presented to the emergency room with 2 weeks of abdominal pain, bloating, and constipation. His history was significant for 2 previous abdominal operations and 40-pack years of smoking. A CT-scan showed circumferential sigmoid thickening. He subsequently underwent a colonoscopy, where an obstructing sigmoid mass approximately 20cm from the anal verge was unable to be traversed. Biopsy demonstrated poorly differentiated adenocarcinoma. The patient was referred to colorectal surgery for management. A pelvic MRI was performed, demonstrating transmural infiltration into the pericolic fat, with distal ileum adherent to the mass. After consent was obtained, the patient was scheduled for a laparoscopic low anterior resection.

The patient was positioned in modified lithotomy, and access to the abdomen was obtained through an open Hassan approach. On inspection, a large, bulky mass was visualized, with distal small bowel adhered, very deep in the pelvis. The small bowel was divided to gain access to the dissection planes around the large mass. A lateral to medial dissection was initially performed to define the presacral plane, avoiding the ureter, nerves, and area of mesorectal invasion. A high division of the IMA was performed, then a medial to lateral dissection was done. The splenic flexure was noted to be high and very close to the colon, making its takedown difficult. Once complete, the rectal planes were well visualized. A total mesorectal dissection was performed, mobilizing the rectum to the anal canal posteriorly. Anteriorly, the pouch of Douglas was incised to aid circumferential mobilization. The rectum and its mesentery were divided at the peritoneal reflection. The small bowel was then externalized through a midline incision, and a stapled side-to-side, functional end anastomosis was performed. The divided rectosigmoid was then exteriorized, and transected proximal to the mass. The EEA anvil was placed, and the sigmoid returned to the peritoneal cavity. A transversus abdominus plane block was placed. Then, a stapled colorectal anastomosis was completed, verifying integrity with a negative leak test. Final pathology on the specimen was T4N2bM0 (Stage IIIC). The patient’s hospital length of stay was 2 days.


Session: Podium Presentation

Program Number: V022

1,155

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals