Skip to main content

Advertisement

SpringerLink
Log in

A surgical solution to regain bowel continuity following an extended left colectomy—reviving and extending the indication for a “Flip-Flop” procedure

  • Short Communication
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Extended left hemicolectomy might be necessary for several indications. Once the resection is completed, it would be difficult or impossible to anastomose the transverse colon to the rectum due to the difficulty in mobilizing the transverse colon to reach for a tension-free rectal anastomosis. The aim of this report is to present the “Flip-Flop” technique to overcome this challenging situation. The procedure is based on a surgical technique published in the early 1960s to avoid permanent stoma after proctectomy and consists of changing the location of the right colon to reach the rectum.

Methods

Clinical parameters, surgical aspects, and postoperative outcome of patients that underwent the flip-flop procedure following an extended left colectomy in our medical service was reviewed.

Results

Three patients underwent a flip-flop procedure after an extended left colectomy performed for various reasons. The surgical technique is detailed in a step by step manner. Patients had uneventful postoperative recovery with an adequate functional outcome.

Conclusions

We believe that this approach should be revived and be considered also in cases when the full length of the rectum is preserved to avoid ileo-rectal anastomosis or a high-tension colocolonic anastomosis. Popularization of this surgical solution among surgeons is highly important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. You YN, Chua HK, Nelson H, Hassan I, Barnes SA, Harrington J (2008) Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life. Dis Colon Rectum 51(7):1036–1043

  2. Eu KW, Lim SL, Seow-Choen F, Leong AF, Ho YH (1998) Clinical outcome and bowel function following total abdominal colectomy and ileorectal anastomosis in the Oriental population. Dis Colon Rectum 41(2):215–218

  3. Lim JF, Ho YH (2001) Total colectomy with ileorectal anastomosis leads to appreciable loss in quality of life irrespective of primary diagnosis. Tech Coloproctol 5(2):79–83

  4. Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R (2007) Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis 9(6):559–561

  5. Vonk-Klaassen SM, de Vocht HM, den Ouden ME, Eddes EH, Schuurmans MJ (2016) Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res 25(1):125–133

  6. Deloyers L (1964) Suspension of the right colon permits without exception preservation of the anal sphincter after extensive colectomy of the transverse and left colon (including rectum)—technique—indications—immediate and late results. Lyon Chir 60:404–413

  7. Kontovounisios C, Baloyiannis Y, Kinross J, Tan E, Rasheed S, Tekkis P (2014) Modified right colon inversion technique as a salvage procedure for colorectal or coloanal anastomosis. Colorectal Dis 16(12):971–975

  8. Manceau G, Karoui M, Breton S, Blanchet AS, Rousseau G, Savier E, Siksik JM, Vaillant JC, Hannoun L (2012) Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes. Dis Colon Rectum 55(3):363–368

  9. Sciuto A, Grifasi C, Pirozzi F, Leon P, Pirozzi RE, Corcione F (2016) Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results. Tech Coloproctol 20(12):865–869

Download references

Author information

Authors and Affiliations

  1. Department of Surgery B, Meir Medical Center, Kfar Saba, Israel

    Ronen Ghinea, Shmuel Avital, Ephraim Katz, Baruch Shpitz & Ian White

  2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ronen Ghinea, Shmuel Avital, Ephraim Katz, Baruch Shpitz & Ian White

Authors
  1. Ronen Ghinea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shmuel Avital
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ephraim Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Baruch Shpitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ian White
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shmuel Avital.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghinea, R., Avital, S., Katz, E. et al. A surgical solution to regain bowel continuity following an extended left colectomy—reviving and extending the indication for a “Flip-Flop” procedure. Int J Colorectal Dis 33, 95–97 (2018). https://doi.org/10.1007/s00384-017-2922-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2922-5

Keywords

Search

Navigation