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Options and outcome for reconstruction after extended left hemicolectomy
Author(s) -
Dumont F.,
Da Re C.,
Goéré D.,
Honoré C.,
Elias D.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12136
Subject(s) - medicine , anastomosis , surgery , transposition (logic) , hemicolectomy , colorectal cancer , linguistics , philosophy , cancer
Aim A tension‐free anastomosis is required to minimize anastomotic leakage after an extended left colectomy when the residual transverse colon is too short to spontaneously reach the pelvis. To resolve this problem, colonic rotation with a right colonic transposition ( RCT ) or even with a complete intestinal derotation ( CID ) is mandatory. This study compared these two techniques. Method Between J anuary 2001 and D ecember 2011, 39 patients had undergone right colonic transposition ( n = 29) or complete intestinal derotation ( n = 10) after an extended left colectomy. All anastomotic complications had been recorded during the follow up. Results No differences were found between right colonic transposition and complete intestinal derotation in terms of patient characteristics, surgical indications, therapeutic features and risk factors for anastomotic leakage (sex, A merican So ciety of A nesthesiology ( ASA ) score, diabetes, bevacizumab use, colorectal anastomotic level or protective stoma use). Ligature of the middle colic artery was significantly more frequent with right colonic transposition than with complete intestinal derotation (82.7% vs 50%; P = 0.04). An additional colonic resection tended to be required more often in the right colonic transposition group than in the complete intestinal derotation group (55.1% vs 20%; P = 0.054). The anastomotic complication rate was 10.2% and was not significantly different between right colonic transposition and complete intestinal derotation (6.9% vs 20%, P = 0.24). Conclusion Both colonic rotation techniques are feasible and safe. The right colonic transposition and complete intestinal derotation techniques yielded similar results in terms of colorectal anastomotic complications, but right colonic transposition required ligature of the middle colic artery and additional colonic resection tended to be required more frequently.