Michael E Dolberg, MD, FACS, FASCRS, Othon Wiltz, MD, FACS, FASCRS, Edith Ruiz, PA, Jeffrey Snow, MD, FACS, FASCRS. Memorial Healthcare System
Purpose: This video presents a case of a 50 year old female with a history of rectal cancer. The tumor was located 8 cm from the anal verge. Endorectal ultrasound revealed a uT3N1 lesion. She received neoadjuvant chemotherapy and radiation. Post treatment flexible sigmoidoscopy displayed a good response to treatment. She was taken to the operating room for a laparoscopic low anterior resection with extraction of the specimen through the ileostomy site. Final pathology showed a complete pathological response with no residual adenocarcinoma and 15 negative lymph nodes. After completing adjuvant chemotherapy, flexible sigmoidoscopy displayed a healed and patent anastomosis located 5 cm from the anal verge. She was brought to the operating room for reversal of the loop ileostomy. She has a history of obesity, with a BMI of 43. Therefore, a laparoscopic approach was used for reversal of the stoma.
Methods: This patient underwent laparoscopic reversal of a loop ileostomy. The abdomen was entered in the right upper quadrant because of her history of gastric band placement. Additional ports were placed in the following positions: supraumbilical (camera port), left lower quadrant (12 mm stapler port), left mid quadrant (5 mm port), epigastric (5 mm assistant port). The bowel was dissected away from attachments to the fascia and a hernia sac. An intra-corporeal side to side anastomosis was then performed. This was done with the bowel aligned in an anti-peristaltic fashion. The remaining subcutaneous portion of the ileostomy was then excised in the standard fashion. The site was closed with a purse string using absorbable suture.
Results: The patient was successfully treated with this minimally invasive technique. She was tolerating a regular diet on POD 2. She also had full return of bowel function on POD 2.
Conclusions: Laparoscopy is a useful tool in the reversal of stomas. Patients with obesity and thick abdominal walls present a challenge when attempting to reverse a loop ileostomy. It can be difficult to dissect the intestine away from the subcutaneous tissue and fascia without creating trauma, or even injury, to the involved bowel. Using a laparoscopic approach, the bowel can be gently brought away from the stoma site and a healthy anastomosis can be achieved.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86598
Program Number: V215
Presentation Session: Thursday Video Loop (Non CME)
Presentation Type: VideoLoop
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