Irbaz Hameed, MD, Emre Gorgun, MD. Cleveland Clinic
In patients with extensive inflammatory bowel disease, a laparoscopic approach is not commonly used due to the limitations of the technique and risk of major complications. In this video, we present a patient with complicated crohn’s disease who underwent laparoscopic subtotal colectomy with ileorectal anastomosis. The patient is a 24-year old man with severe Crohn’s disease for several years who presented with persistent left sided abdominal pain. He had no prior bowel resection and was refractory to medical treatment. CT scan revealed strictures in the descending colon, as well as in the terminal ileum and presence of an entero-colonic fistula. As evident from the CT scans and subsequent intraoperative findings, the colon was found to be extensively diseased, and decision was taken to resect the entire colon. The surgery begun with a careful assessment of problems and small jejunal loops were found to be attached to the strictured segment. These were at first, sharply taken down and mobilized. Subtotal colectomy was performed laparoscopically with creation of end-to-end ileorectal stapled anastomosis and proximal diverting loop ileostomy. The patient recovered completely from surgery with no immediate or post-procedural complications. Laparoscopic surgery is less invasive and effective for the management of complicated inflammatory bowel disease. The technique can be utilized for extensive bowel resection and repair with minimal post-operative scarring and faster recovery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94273
Program Number: V406
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop