Laparoscopic Left and Sigmoid Colectomy: Options for Colonic and Colorectal Reconstruction
Construction of a safe and healthy anastomosis following a colon or rectal resection is one of the critical steps of the entire operation. There are many options for the type of reconstruction to be performed. All options must include all of the following features: adequate blood supply to the bowel, utilization of healthy bowel, adequate mobilization to avoid tension on the anastomosis, and some form of anastomotic assessment. It is also critical for the surgeon to understand the patient, disease, and surgeon-related factors that impact the creation of a successful anastomosis. Unfortunately, not every anastomosis is straightforward, so surgeons must also be facile with techniques and maneuvers to overcome intraoperative challenges associated with restoring intestinal continuity. This chapter will address many of the technical aspects of the various types of bowel reconstruction, management of intraoperative issues, and will discuss the outcomes of left-sided colon reconstructions.
KeywordsAnastomosis Anastomotic testing Colonic J pouch Coloplasty Baker’s anastomosis
- 1.Rojas-Machado SA, Romero-Simó M, Arroyo A, Rojas-Machado A, López J, Calpena R. Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta-analysis of observational studies of risk factors. Int J Color Dis. 2016;31(2):197–210.CrossRefGoogle Scholar
- 2.Jim JH, Kim HY, Lee IK, Oh ST, Kim JG, Lee YS. Intra-operative double-stapled colorectal or coloanal anastomosis complications of laparoscopic low anterior resection for rectal cancer: double-stapled anastomotic complication could result in persistent anastomotic leakage. Surg Endosc. 2015;(11):3117–24.Google Scholar
- 15.Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg. 2015;262(2):331–7.CrossRefGoogle Scholar
- 17.Marti WR, Curti G, Wehrli H, Grieder F, Graf M, Gloor B, et al. Clinical outcome after rectal replacement with side-to-end, Colon-J-Pouch, or straight colorectal anastomosis following total mesorectal excision: a Swiss prospective, randomized, multicenter trial (SAKK 40/04). Ann Surg. 2019;269(5):827–35.CrossRefGoogle Scholar