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
Introduction: 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) w...
| Autores: | , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Navarra |
| Repositorio: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglés |
| OAI Identifier: | oai:dnet:dadun_______::be743e99846b55284ac19a4317756c2f |
| Acceso en línea: | https://hdl.handle.net/10171/124229 |
| Access Level: | acceso abierto |
| Palabra clave: | Colonic derotation Complete mesocolic excision Deloyers procedure Embryology Left extended colectomy Splenic flexure carcinoma |
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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 |
| title |
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 |
| spellingShingle |
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 Di-Saverio, S. (Salomone)|||/items/3a7ba5ca-e262-4b8b-a7d3-e1ac635e9d2b Colonic derotation Complete mesocolic excision Deloyers procedure Embryology Left extended colectomy Splenic flexure carcinoma |
| title_short |
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 |
| title_full |
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 |
| title_fullStr |
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 |
| title_full_unstemmed |
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 |
| title_sort |
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 |
| dc.creator.none.fl_str_mv |
Di-Saverio, S. (Salomone)|||/items/3a7ba5ca-e262-4b8b-a7d3-e1ac635e9d2b Stasinos, K. (Kostantinos)|||/items/2ed6aaee-d4d1-4b6b-821e-b02f2111d732 Stupalkowska, W. (Weronyka)|||/items/f0f461ee-3312-4e3c-a1d5-fab23c02413b Bracale, U. (Umberto)|||/items/258ecb02-34b1-432e-9098-1f51ee3c7510 Siler, P. (Pierpaolo)|||/items/5675aa4f-55b5-4679-9ba3-ca2277820c9a Giuliani, A. (Antonio)|||/items/4cae363b-5e94-46fa-b6aa-84908fb1e686 Nigri, G. (Giuseppe)|||/items/2523ddf4-eaef-46ce-81c0-357c98656c50 Kouroumpas, E. (Efstratios)|||/items/13d43041-8a5a-4a60-b9a0-8be4a2f1068c Wheeler, J. (James)|||/items/33d4281c-124e-44ae-9d25-6c7927dd84c2 Tebala, G.D. (Giovanni Domenico)|||/items/35808c44-36ad-4215-8a01-7bd218a90d83 Di-Marzo, F. (Francesco)|||/items/cdedd1ae-1fcf-4b26-8616-abbf74b84f00 De-Simone, B. (Belinda)|||/items/55fdc1ab-af00-4c49-85e6-8364dfae6ebe Pastor-Idoate, C. (Carlos)|||/items/db004f1c-c96b-428d-b929-408dda2c568d De-Angelis, N. (Nicola)|||/items/ec05c83b-2603-4a28-9004-e1baf7dc63b1 Cirocchi, R. (Roberto)|||/items/20a97c64-a0df-4902-bc2b-ec2dc4f77201 Tejedor, P. (Patricia)|||/items/c8cf204b-6d47-4b25-8bd3-c0a9ee3f7bdc |
| author |
Di-Saverio, S. (Salomone)|||/items/3a7ba5ca-e262-4b8b-a7d3-e1ac635e9d2b |
| author_facet |
Di-Saverio, S. (Salomone)|||/items/3a7ba5ca-e262-4b8b-a7d3-e1ac635e9d2b Stasinos, K. (Kostantinos)|||/items/2ed6aaee-d4d1-4b6b-821e-b02f2111d732 Stupalkowska, W. (Weronyka)|||/items/f0f461ee-3312-4e3c-a1d5-fab23c02413b Bracale, U. (Umberto)|||/items/258ecb02-34b1-432e-9098-1f51ee3c7510 Siler, P. (Pierpaolo)|||/items/5675aa4f-55b5-4679-9ba3-ca2277820c9a Giuliani, A. (Antonio)|||/items/4cae363b-5e94-46fa-b6aa-84908fb1e686 Nigri, G. (Giuseppe)|||/items/2523ddf4-eaef-46ce-81c0-357c98656c50 Kouroumpas, E. (Efstratios)|||/items/13d43041-8a5a-4a60-b9a0-8be4a2f1068c Wheeler, J. (James)|||/items/33d4281c-124e-44ae-9d25-6c7927dd84c2 Tebala, G.D. (Giovanni Domenico)|||/items/35808c44-36ad-4215-8a01-7bd218a90d83 Di-Marzo, F. (Francesco)|||/items/cdedd1ae-1fcf-4b26-8616-abbf74b84f00 De-Simone, B. (Belinda)|||/items/55fdc1ab-af00-4c49-85e6-8364dfae6ebe Pastor-Idoate, C. (Carlos)|||/items/db004f1c-c96b-428d-b929-408dda2c568d De-Angelis, N. (Nicola)|||/items/ec05c83b-2603-4a28-9004-e1baf7dc63b1 Cirocchi, R. (Roberto)|||/items/20a97c64-a0df-4902-bc2b-ec2dc4f77201 Tejedor, P. (Patricia)|||/items/c8cf204b-6d47-4b25-8bd3-c0a9ee3f7bdc |
| author_role |
author |
| author2 |
Stasinos, K. (Kostantinos)|||/items/2ed6aaee-d4d1-4b6b-821e-b02f2111d732 Stupalkowska, W. (Weronyka)|||/items/f0f461ee-3312-4e3c-a1d5-fab23c02413b Bracale, U. (Umberto)|||/items/258ecb02-34b1-432e-9098-1f51ee3c7510 Siler, P. (Pierpaolo)|||/items/5675aa4f-55b5-4679-9ba3-ca2277820c9a Giuliani, A. (Antonio)|||/items/4cae363b-5e94-46fa-b6aa-84908fb1e686 Nigri, G. (Giuseppe)|||/items/2523ddf4-eaef-46ce-81c0-357c98656c50 Kouroumpas, E. (Efstratios)|||/items/13d43041-8a5a-4a60-b9a0-8be4a2f1068c Wheeler, J. (James)|||/items/33d4281c-124e-44ae-9d25-6c7927dd84c2 Tebala, G.D. (Giovanni Domenico)|||/items/35808c44-36ad-4215-8a01-7bd218a90d83 Di-Marzo, F. (Francesco)|||/items/cdedd1ae-1fcf-4b26-8616-abbf74b84f00 De-Simone, B. (Belinda)|||/items/55fdc1ab-af00-4c49-85e6-8364dfae6ebe Pastor-Idoate, C. (Carlos)|||/items/db004f1c-c96b-428d-b929-408dda2c568d De-Angelis, N. (Nicola)|||/items/ec05c83b-2603-4a28-9004-e1baf7dc63b1 Cirocchi, R. (Roberto)|||/items/20a97c64-a0df-4902-bc2b-ec2dc4f77201 Tejedor, P. (Patricia)|||/items/c8cf204b-6d47-4b25-8bd3-c0a9ee3f7bdc |
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author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
Colonic derotation Complete mesocolic excision Deloyers procedure Embryology Left extended colectomy Splenic flexure carcinoma |
| topic |
Colonic derotation Complete mesocolic excision Deloyers procedure Embryology Left extended colectomy Splenic flexure carcinoma |
| description |
Introduction: 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. |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022 2022-01-01 2022 2022-01-01 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/10171/124229 |
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https://hdl.handle.net/10171/124229 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
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open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
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application/pdf |
| dc.publisher.none.fl_str_mv |
Springer Nature |
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Springer Nature |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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1869414300566683648 |
| spelling |
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 vesselsDi-Saverio, S. (Salomone)|||/items/3a7ba5ca-e262-4b8b-a7d3-e1ac635e9d2bStasinos, K. (Kostantinos)|||/items/2ed6aaee-d4d1-4b6b-821e-b02f2111d732Stupalkowska, W. (Weronyka)|||/items/f0f461ee-3312-4e3c-a1d5-fab23c02413bBracale, U. (Umberto)|||/items/258ecb02-34b1-432e-9098-1f51ee3c7510Siler, P. (Pierpaolo)|||/items/5675aa4f-55b5-4679-9ba3-ca2277820c9aGiuliani, A. (Antonio)|||/items/4cae363b-5e94-46fa-b6aa-84908fb1e686Nigri, G. (Giuseppe)|||/items/2523ddf4-eaef-46ce-81c0-357c98656c50Kouroumpas, E. (Efstratios)|||/items/13d43041-8a5a-4a60-b9a0-8be4a2f1068cWheeler, J. (James)|||/items/33d4281c-124e-44ae-9d25-6c7927dd84c2Tebala, G.D. (Giovanni Domenico)|||/items/35808c44-36ad-4215-8a01-7bd218a90d83Di-Marzo, F. (Francesco)|||/items/cdedd1ae-1fcf-4b26-8616-abbf74b84f00De-Simone, B. (Belinda)|||/items/55fdc1ab-af00-4c49-85e6-8364dfae6ebePastor-Idoate, C. (Carlos)|||/items/db004f1c-c96b-428d-b929-408dda2c568dDe-Angelis, N. (Nicola)|||/items/ec05c83b-2603-4a28-9004-e1baf7dc63b1Cirocchi, R. (Roberto)|||/items/20a97c64-a0df-4902-bc2b-ec2dc4f77201Tejedor, P. (Patricia)|||/items/c8cf204b-6d47-4b25-8bd3-c0a9ee3f7bdcColonic derotationComplete mesocolic excisionDeloyers procedureEmbryologyLeft extended colectomySplenic flexure carcinomaIntroduction: 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.Springer NatureDadun. Depósito Académico Digital Universidad de Navarra20222022-01-0120222022-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/124229reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dnet:dadun_______::be743e99846b55284ac19a4317756c2f2026-06-21T12:47:57Z |
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15,811543 |