"How I Do It"-Radical Right Colectomy with Side-to-Side Stapled Ileo-Colonic Anastomosis.

Details

Serval ID
serval:BIB_0DDDAE13460A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
"How I Do It"-Radical Right Colectomy with Side-to-Side Stapled Ileo-Colonic Anastomosis.
Journal
Journal of Gastrointestinal Surgery
Author(s)
Hübner M., Larson D.W., Wolff B.G.
ISSN
1873-4626 (Electronic)
ISSN-L
1091-255X
Publication state
Published
Issued date
2012
Volume
16
Number
8
Pages
1605-1609
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND AND OBJECTIVE: Standardization of surgical technique helps to reproduce excellent clinical outcomes, especially in teaching institutions. We aim to describe in detail our established approach for oncological right colectomy.
TECHNIQUE: The right colon is mobilized in a five-step latero-inferior approach starting off with (1) the terminal ileum, visualizing the duodenum and the head of pancreas. (2) The ascending colon is dissected from the retroperitoneum, and takedown of the hepatic flexure is completed coming retrograde from the transverse colon (3). (4) Transection of the remaining retroperitoneal attachments completes exposure of the duodenum and mobilization of the right colon. (5) Ileocolic vessels are dissected out and divided close to their origin, and the mesocolon is divided. We then establish intestinal continuity by use of a side-to-side stapled technique. (1) The arms of a linear cutting stapler are inserted via transverse incisions at the anti-mesenteric sides of the terminal ileum and the transverse colon (tenia) and fired. (2) The enterotomy site is closed by removal of the specimen using a second transverse firing of the linear cutting stapler. An important final step is the (3) reinforcement of the anastomotic ends and the crossing of the staple lines; an omental patch and closure of the mesenteric window are optional.
CONCLUSION: The suggested standardized five-step lateral-to-medial dissection of the right colon and the three-step side-to-side stapled technique for ileo-colonic anastomosis are easy to learn and to reproduce. Careful adherence to pivotal technical details will help to obtain an optimal oncological outcome and a consistently low leak rate around 2 %.
Pubmed
Web of science
Create date
18/08/2012 9:59
Last modification date
20/08/2019 12:34
Usage data