Repository logo
 

Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels.

Simple item page
cam.issuedOnline2021-07-16
dc.contributor.authorDi Saverio, Salomone
dc.contributor.authorStasinos, Kostantinos
dc.contributor.authorStupalkowska, Weronyka
dc.contributor.authorBracale, Umberto
dc.contributor.authorSileri, Pierpaolo
dc.contributor.authorGiuliani, Antonio
dc.contributor.authorNigri, Giuseppe
dc.contributor.authorKouroumpas, Efstratios
dc.contributor.authorWheeler, James MD
dc.contributor.authorTebala, Giovanni Domenico
dc.contributor.authorDi Marzo, Francesco
dc.contributor.authorDe Simone, Belinda
dc.contributor.authorIdoate, Carlos Pastor
dc.contributor.authorDe Angelis, Nicola
dc.contributor.authorCirocchi, Roberto
dc.contributor.authorTejedor, Patricia
dc.date.accessioned2022-02-16T16:01:25Z
dc.date.available2022-02-16T16:01:25Z
dc.date.issued2022-02
dc.date.submitted2021-03-11
dc.date.updated2022-02-16T16:01:18Z
dc.descriptionFunder: Università degli Studi dell'Insubria
dc.description.abstractINTRODUCTION: This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. BACKGROUND: While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. TECHNIQUE AND METHODS: Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. RESULTS: This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. CONCLUSIONS: Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.
dc.identifier.doi10.17863/CAM.81502
dc.identifier.eissn1435-2451
dc.identifier.issn1435-2443
dc.identifier.others00423-021-02240-7
dc.identifier.other2240
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/334092
dc.languageen
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.publisher.urlhttp://dx.doi.org/10.1007/s00423-021-02240-7
dc.subjectColonic derotation
dc.subjectComplete mesocolic excision
dc.subjectDeloyers procedure
dc.subjectEmbryology
dc.subjectLeft extended colectomy
dc.subjectSplenic flexure carcinoma
dc.subjectAdenocarcinoma
dc.subjectAged
dc.subjectAnastomosis, Surgical
dc.subjectColectomy
dc.subjectColic
dc.subjectColon, Transverse
dc.subjectColonic Neoplasms
dc.subjectFemale
dc.subjectHumans
dc.subjectLaparoscopy
dc.titleLong splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels.
dc.typeArticle
dcterms.dateAccepted2021-06-09
prism.endingPage428
prism.issueIdentifier1
prism.publicationNameLangenbecks Arch Surg
prism.startingPage421
prism.volume407
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1007/s00423-021-02240-7

Files

Original bundle
Now showing 1 - 3 of 3
No Thumbnail Available
Name:
additional-files.zip
Size:
283.42 MB
Format:
ZIP file
Description:
Supporting information
Licence
http://creativecommons.org/licenses/by/4.0/
Download
No Thumbnail Available
Name:
423_2021_Article_2240_nlm.xml
Size:
52.44 KB
Format:
Extensible Markup Language
Description:
Bibliographic metadata
Licence
http://creativecommons.org/licenses/by/4.0/
Download
Thumbnail Image
Name:
423_2021_Article_2240.pdf
Size:
1.45 MB
Format:
Adobe Portable Document Format
Description:
Published version
Licence
http://creativecommons.org/licenses/by/4.0/
Download

Collections

Jisc Publications Router