Emma K Gibson, BS, Jacqueline J Blank, MD, Timothy J Ridolfi, MD, Kirk A Ludwig, MD. Medical College of Wisconsin
Introduction: Following a generous left hemicolectomy an anastomosis between the transverse colon and rectum may be required. Extensive mobilization and retroileal routing is sometimes necessary to create a tension-free anastomosis. Retroileal routing is a technique in which a window is created in the ilieocolic mesentery. The colon is routed through this window, beneath the ileum, prior to entering the pelvis. Retroileal routing is uncommon and there is no data on this technique when performed in using a hand-assisted laparoscopic technique. The aim of this study was to review our experience with hand-assisted laparoscopic left sided colon resections including retroileal routing of the proximal colon to the rectum.
Methods and Procedures: We performed a retrospective review of a single surgeon’s experience with hand-assisted laparoscopic left sided resections over a seven-year period from 2008-2015. Indication for operation, basic demographics, BMI, procedure time, short- and long-term morbidity, and mortality were recorded.
Results: A total of 340 patients underwent a hand-assisted laparoscopic left sided resection with a colorectal or coloanal anastomosis. Of these, 13 underwent hand-assisted laparoscopic procedures with retroileal routing of the proximal colon. In each case, operations included a midline hand port incision and two 5 mm ports in the lower abdomen. The indications for operation were diverticular disease and neoplasm in nine and four patients respectively. Procedures took an average of 188.6 (128-221) minutes to complete. Postoperative morbidity included intubation for CO2 retention in one patient and a RLL effusion in another patient. There were no anastomotic leaks and there were no 30-day or 90-day mortalities.
Conclusion: Retroileal routing of the colon following left hemicolectomy occurs infrequently. A hand-assisted laparoscopic approach appears to be a safe and efficient in these technically challenging cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88323
Program Number: P489
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster