Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore.
Division of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan.
Colorectal Dis. 2021 May;23(5):1262-1267. doi: 10.1111/codi.15501. Epub 2021 Jan 11.
Following extended left-sided colorectal resection, creation of the anastomosis can be challenging due to insufficient length of the remaining proximal and distal bowel. Retroileal pull-through and the Deloyers procedure are feasible but require ligation of the middle colic vessels and additional right colonic mobilization. The aim of this study was to describe our initial experience with an alternative technique for performing tension-free anastomosis following minimally invasive left-sided resection.
This was a retrospective case series of all patients who underwent a retrojejunal trans-mesenteric pull-through following elective laparoscopic left-sided colorectal surgery between September 2019 and September 2020. Placing the retrojejunal window 15-20 cm distal to the duodenojejunal junction allows the transverse colon to pass via the most direct route through the base of the proximal jejunal mesentery to the distal colon or rectal stump instead of passing over the small bowel, yielding additional length for the anastomosis. An accompanying video demonstrates this technique for three different case scenarios.
Seven consecutive patients underwent this approach following colorectal resection; three had inherently shorter left colons, two had synchronous left-sided tumours and two had inadvertent intraoperative marginal artery injury. There were no anastomotic complications or early postoperative morbidity related to the mesenteric window. The additional time taken for the procedure ranged from 5 to 35 min. The risk of complications related to extended left-sided resections may possibly be reduced, although further studies are required to evaluate this.
Retrojejunal trans-mesenteric pull-through is a novel, but straightforward, safe and useful option for reducing tension in laparoscopic left-sided colorectal anastomoses.
左半结直肠切除术后，由于剩余近端和远端肠管长度不足，吻合口的创建可能具有挑战性。回肠经后腹膜拖出和 Deloyers 手术是可行的，但需要结扎中间结肠血管并进一步游离右半结肠。本研究旨在描述我们在微创左半结肠切除术后行无张力吻合的替代技术的初步经验。
这是一项回顾性病例系列研究，纳入 2019 年 9 月至 2020 年 9 月期间择期行腹腔镜左半结直肠手术的所有患者，这些患者均行选择性腹腔镜左半结直肠手术，并在术后行回肠经系膜后拖出术。将回肠系膜后窗置于十二指肠空肠连接处远端 15-20cm 处，使横结肠能够通过最直接的路径穿过近端空肠系膜基底到达远端结肠或直肠残端，而不是越过小肠，从而为吻合口提供额外的长度。一段配套视频演示了三种不同病例场景下的该技术。
7 例连续患者在结直肠切除术后采用该方法；其中 3 例固有左结肠较短，2 例同时存在左侧肿瘤，2 例术中意外发生边缘动脉损伤。系膜窗无吻合口并发症或早期术后并发症。该手术的额外时间为 5 至 35 分钟。尽管还需要进一步的研究来评估，但与广泛左半结肠切除相关的并发症风险可能会降低。
回肠经后腹膜系膜拖出术是一种新颖但简单、安全且有用的方法，可减少腹腔镜左半结直肠吻合的张力。
