Di Saverio S, Birindelli A, Mandrioli M, Podda M, Binda G A
Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
General and Emergency Surgery, San Marcellino Hospital, Muravera, Italy.
Colorectal Dis. 2017 Apr;19(4):O103-O107. doi: 10.1111/codi.13642.
Laparoscopy offers the benefits of minimally invasive surgery and faster recovery. Acute surgical patients may potentially benefit from the great advantages of emergency laparoscopy, which is more clinically relevant in acute than elective patients. Fashioning a laparoscopic intracorporeal anastomosis (ICA) after emergent colorectal resection, whenever technically feasible and not contraindicated by the patient's general and haemodynamic condition, is a most challenging technical skill.
During the period 2010-2016, 59 patients underwent a laparoscopic procedure for colorectal emergency in an acute care setting by a single operating surgeon with advanced laparoscopic skills and specific expertise in both colorectal surgery and acute care surgery. This series includes 32 laparoscopic right colectomies (12 for obstruction and 20 for perforation/peritonitis) and 27 left colectomies (6 for obstruction and 21 for perforation/peritonitis). Twenty-eight ileocolic side-to-side ICA, and 27 left colonic ICA (3 colocolic, 24 colorectal) were performed.
Reasonably good postoperative outcomes were observed in the entire series of 59 laparoscopic colectomies performed in an urgent setting. Overall, the major morbidity rate in the entire group was 16.9% (10/59) with an incidence of intra-abdominal abscess of 11.8% (7/59); the overall leak rate was 3.4% (2/59). The re-operation rate was 3.4% (2/59). A video included in the Supporting Information shows five different sites and techniques for ICA and describes technical details with tips and tricks. All patients shown in the video had an uneventful postoperative recovery and were managed postoperatively according to enhanced recovery after surgery protocols.
This case series illustrates all possible sites and techniques for colonic ICA in an emergency setting. All colorectal and acute care surgeons should have laparoscopic suturing skills.
腹腔镜手术具有微创手术和恢复更快的优点。急性外科手术患者可能会从急诊腹腔镜手术的巨大优势中获益，这在急性患者中比择期患者更具临床相关性。在急诊结直肠切除术后进行腹腔镜体内吻合术（ICA），只要技术上可行且患者的一般情况和血流动力学状况无禁忌，是一项极具挑战性的技术技能。
在2010年至2016年期间，59例患者在急性护理环境中由一位具备先进腹腔镜技术以及结直肠手术和急性护理手术特定专业知识的外科医生进行了腹腔镜结直肠急诊手术。该系列包括32例腹腔镜右半结肠切除术（12例因梗阻，20例因穿孔/腹膜炎）和27例左半结肠切除术（6例因梗阻，21例因穿孔/腹膜炎）。进行了28例回结肠侧侧ICA和27例左结肠ICA（3例结肠结肠吻合，24例结肠直肠吻合）。
在紧急情况下进行的整个59例腹腔镜结肠切除术系列中观察到了相当不错的术后结果。总体而言，整个组的主要发病率为16.9%（10/59），腹腔内脓肿发生率为11.8%（7/59）；总体渗漏率为3.4%（2/59）。再次手术率为3.4%（2/59）。补充信息中的一段视频展示了ICA的五个不同部位和技术，并描述了技术细节及技巧。视频中展示的所有患者术后恢复顺利，并根据术后加速康复方案进行术后管理。
本病例系列阐述了紧急情况下结肠ICA的所有可能部位和技术。所有结直肠和急性护理外科医生都应具备腹腔镜缝合技能。
