Technical considerations for an intracorporeal anastomosis after a right colectomy
Antonio De Lacy
Director Instituto Quirurgico Lacy at Hospital Quiron Barcelona, Hospital Ruber Internacional Madrid and Clinica Rotger Palma de Mallorca
To perform an intracorporeal anastomosis after a right colectomy is ideal for patients with morbid obesity or bulky mesentery. This strategy allows a smaller incision at the abdominal wall and prevents increased traction to the mesentery during the exteriorization of the specimen. Wound protection is recommended to preserve oncological safety.This video reflects the basics steps to perform an intracorporeal ileum-transverse anastomosis. First it is necessary to maintain together the ileum and the colon, a knot is performed to accomplish this maneuver.
It is important to calculate the length of the loops involved in the anastomosis, to avoid complications associated with a blind loop. The abdominal wall is revised to select the correct place for extraction of the thread holder is introduced into the abdomen to catch the suture and accomplish careful traction.
The surgeon verifies the future orientation of the mechanical stapler, a colotomy and enterotomy is performed to allow the introduction of the mechanical stapler. The tip must go in direction of the knot extracted through the abdominal wall.
Simultaneous countertraction of the gut and colon must be performed to help with the placement of the EndoStapler and avoid torsion. At this point, all is settled for the firing.
A running suture of V-Lock is used to close the defect, a barbed suture improves the surgical time. It is easier to perform it as the first knot is avoided, it is also easier to maintain tension and enhance the security of the anastomosis. The last knot involves the epiplon to create a patch.
Finally the knot of traction is cut and another is performed to release the anastomotic tension.
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