Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.
World J Surg Oncol. 2023 May 5;21(1):140. doi: 10.1186/s12957-023-03026-5.
Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL), and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure - a novel-combining (cranial, medial to lateral, and caudal) approach with early resection of the terminal ileum.
The dissection stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: cranial approach, dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein and then exposed the right gastroepiploic vein and the trunk of Henle; medial-to-lateral approach, exposing the surgical axis - the superior mesenteric vascular axis and then early resection of the terminal ileum to open the dissection from the bottom up; and caudal approach, radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy), and resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall.
In 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRH based on the Bach Mai Procedure. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number which was 101. No serious postoperative complications (grade 3 or higher) neither inhospital mortality was detected.
This Bach Mai procedure, a novel-combining approach with early resection of the terminal ileum, is technically feasible and safe for tLRH. Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.
全腹腔镜右半结肠切除术（total laparoscopic right hemicolectomy，TLRH）联合完整结肠系膜切除术（complete mesocolic excision，CME）、中央血管结扎术（central vascular ligation，CVL）和 D3 淋巴结清扫术仍然是胃肠道外科医生最具挑战性的结肠手术之一。本文报告了一种新的联合（颅侧、内侧到外侧和尾侧）入路与末端回肠早期切除相结合的技术细节及其初步经验——Bach Mai 手术。
在以下四个步骤中采用联合多途径进行中央血管隔离和结扎：颅侧途径，沿胰腺峡部下方解剖以显露中结肠血管和肠系膜上静脉前壁，然后显露胃网膜右静脉和干；内侧到外侧途径，显露手术轴——肠系膜上血管轴，然后早期切除末端回肠，从下至上打开解剖；尾侧途径，根治性结扎回结肠动脉和右结肠动脉（中央血管结扎）、淋巴结清扫（D3 淋巴结清扫），并切除结肠的 Toldt 筋膜，使整个右半结肠从腹壁游离。
在 12 个月的时间里，有 32 例原发性右半结肠癌患者基于 Bach Mai 手术行 tLRH。其中 3 例（9.4%）肿瘤部位在肝曲。淋巴结数量（LNN）中位数为 38 个，最多为 101 个。未发现严重的术后并发症（3 级或以上）或住院期间死亡。
这种 Bach Mai 手术，一种新的联合入路与末端回肠早期切除相结合，对于 tLRH 是技术上可行且安全的。需要进一步的调查和随访来评估我们技术的长期结果。
