Re-do laparoscopic assisted surgery for Crohn’s Disease

Shota Takano, MD, Natalia P Severino, MD, Giovanna DaSilva, MD, Steven D Wexner, MD, PhDHon, FACS, FRCS, FRCSEd. Department of Colorectal Surgery, Cleveland Cliic Florida.

The purpose of this video is to demonstrate the operative technique of laparoscopic assisted re-do ileocolic resection along with sigmoidectomy in a patient with Crohn’s disease complicated with enterocolic fistula.The 39 years old patient underwent open small bowel partial resection and 10 years later was readmitted with symptoms of small bowel obstruction. The CAT scan showed terminal ileum wall thickness and an enterosigmoid fistula. Therefore, the patient underwent laparoscopic assisted ileocolic resection, sigmoidectomy, ileocolic and colorectal extracorporeal anastomosis. Despite the thickness and friability of the mesentery, the large phlegmon and the fibrotic narrowed fistula area, the procedure could be concluded properly and safely. This surgery can be challenging at times leading to difficult dissection and increased risk of bleeding. Patient was started clear liquid diet on 3 postoperative day and discharged on 6 postoperative day. His postoperative course was uncomplicated.
The advantages of using the laparoscopic assisted technique for reoperation in Crohn’s disease are demonstrated: less surgical trauma, better visualization of hepatic and splenic flexures enabling a safer mobilization of the colon, and excellent cosmetics.

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