Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan.
A Fingerhut Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
Colorectal Dis. 2020 Sep;22(9):1189-1194. doi: 10.1111/codi.15018. Epub 2020 Mar 13.
After extended left colectomy, traditional colorectal anastomosis is often not feasible because of insufficient length of the remaining colon to perform a tension-free anastomosis. Total colectomy with ileorectal anastomosis could be an alternative but this can lead to unsatisfactory quality of life. Trans-mesenteric colorectal anastomosis or inverted right colonic transposition (the so-called Deloyers procedure) are two possible solutions for creating a tension-free colorectal anastomosis after extended left colectomy. Few studies have reported their results of these two techniques and mostly via laparotomy. The aim of this study was to describe the trans-mesenteric colorectal anastomosis and the inverted right colonic transposition procedure via a laparoscopic approach and report the outcome in a series of 13 consecutive patients.
This was retrospective chart review of laparoscopic colorectal surgery with trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure from January 2015 up to 2019. An accompanying video demonstrates these two techniques.
Thirteen consecutive patients underwent either a laparoscopic trans-mesenteric colorectal anastomosis (n = 9) or an inverted right colonic transposition procedure (n = 4). One patient had intra-operative presacral bleeding that was stopped successfully without conversion. Two patients had a postoperative intra-abdominal abscess, but no anastomotic complications were recorded. The median number of bowel movements per day after 6 months was 2 (range 2-5).
Trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure is feasible laparoscopically. The now well-established classical advantages of the laparoscopic approach are associated with good functional outcome after these procedures.
左半结肠广泛切除后，由于剩余结肠长度不足，传统的结直肠吻合术往往不可行，无法实现无张力吻合。全结肠切除加回肠直肠吻合术可能是一种替代方法，但这可能导致生活质量不满意。经肠系膜结直肠吻合术或倒置右结肠转位（所谓的 Deloyers 手术）是在左半结肠广泛切除后创建无张力结直肠吻合术的两种可能解决方案。很少有研究报道这两种技术的结果，且大多通过剖腹手术进行。本研究的目的是描述经肠系膜结直肠吻合术和倒置右结肠转位术的腹腔镜方法，并报告 13 例连续患者的结果。
这是对 2015 年 1 月至 2019 年期间进行的腹腔镜结直肠手术中经肠系膜结直肠吻合术或倒置右结肠转位术的回顾性图表分析。一段视频演示了这两种技术。
13 例连续患者接受了腹腔镜经肠系膜结直肠吻合术（n=9）或倒置右结肠转位术（n=4）。1 例患者术中发生骶前出血，成功止血，无需中转开腹。2 例患者术后出现腹腔脓肿，但无吻合口并发症记录。术后 6 个月，每天排便次数中位数为 2 次（范围 2-5 次）。
经肠系膜结直肠吻合术或倒置右结肠转位术可通过腹腔镜完成。现在已经确立的腹腔镜手术的经典优势与这些手术后良好的功能结果相关。
