Laparoscopy sigmoidectomy- an intracorporeal anastomosis for minimally invasive approach to sigmoid surgery in our center: a case report

Authors

  • Pigur Agus Marwanto Department of Surgery, University of Sebelas Maret, DR Moewardi Hospital, Surakarta, Indonesia
  • Anung Noto Nugroho Department of Surgery, University of Sebelas Maret, DR Moewardi Hospital, Surakarta, Indonesia

DOI:

https://doi.org/10.18203/2349-2902.isj20241746

Keywords:

Sigmoid cancer, Intracorporeal anastomosis, Laparoscopic sigmoidectomy

Abstract

Rectosigmoid cancer is the 3rd high prevalence in the world and Indonesia. Surgical management is performed by resection with margins on the proximal and distal sides of the tumor. Improving optimal quality of life by minimizing complications including anastomotic leak, post-operative abscess, surgical site infection as well as decreasing time to discharge and quicker recovery. Minimally invasive ileocolic and colorectal anastomoses may be performed using intracorporeal or extracorporeal techniques. Intracorporeal laparoscopic is reported to be superior as it minimizes bleeding and serosal injuries leading to less postoperative complication of ileus and incisional hernia. Reported a case of laparoscopic sigmoidectomy with resection intracorporeal anterior anastomosis in a 68-year-old male patient with sigmoid cancer. Three trochanter port 12 mm was used subumbilical, 2 cm above anterior superior iliac spine and 5 cm under right mid clavicle line. Counter traction was performed, descending colon was pulled medially opening the plane caudally to the promontorium of the sacrum and medial to distal dissection was performed. The mesentery of the descending colon and retroperitoneum are opened, the anterior surface of Gerota's fascia along Toldt white line to the spleen flexure. Resection for sigmoid was performed 10 cm from proximal and 5 cm from distal sigmoid tumor. Anastomosis colon descendent and rectum using endo GIA 60 mm stappled and suture the defect using V Loc 3.0, identified leaks test was negative. The specimen was extracted out using Pfannenstiel incision. Management of laparoscopic sigmoidectomy using intracorporeal anastomosis for rectosigmoid carcinoma was effective. The patient was discharged from the hospital on the 3rd day. Evaluation was performed until 2 weeks, complications during follow-up were not found, and clinical improvement was reported.

References

Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, et al. Global burden of colorectal cancer in 2020 and 2040: Incidence and mortality estimates from GLOBOCAN. Gut. 2023;72:338–44.

Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Pineros M, et al. Indonesia. In: Global Cancer Observatory: Cancer Today; 2020.

Puspitaningtyas H, Hutajulu SH, Fachiroh J, Anggorowati N, Sanjaya GY, Lazuardi L, Sripan P. Diverging likelihood of colon and rectal cancer in Yogyakarta, Indonesia: A cross sectional study. PLoS One. 2024;19(3):e0301191.

Staib L, Link KH, Blatz A, Beger HG. Surgery of colorectal cancer: surgical morbidity and five and ten year results in 2400 patients monoinstitutional experience. World J Surg. 2002;26:59-66.

Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg. 2004;240(2):260-8.

Brown RF, Cleary RK. Intracorporeal anastomosis versus extracorporeal anastomosis for minimally invasive colectomy. J Gastrointest Oncol. 2020;11(3):500-7.

Martijn P, Eva H, Miguel C, Alois F, Antonio L, Wim H, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The lancet oncology. 2013;14:10.

Zhu QL, Feng B, Lu AG, Wang ML, Hu WG, Li JW, et al. Laparoscopic low anterior resection for rectal carcinoma: complications and management in 132 consecutive patients. World J Gastroenterol. 2010;16(36):4605-10.

Lee WS, Yun SH, Roh YN, Yun HR, Lee WY, Cho YB, et al. Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg. 2008;32:1124-9.

Zhu QL, Feng B, Lu AG, Wang ML, Hu WG, Li JW, et al. Laparoscopic low anterior resection for rectal carcinoma: complications and management in 132 consecutive patients. World J Gastroenterol. 2010;16(36):4605-10.

Dayal S, Battersby N, Cecil T. Evolution of surgical treatment for rectal cancer: a review. J Gastrointest Surg. 2017;21:1166-73.

Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006;76:579-85.

Ferrara M, Kann BR. Urological Injuries during Colorectal Surgery. Clin Colon Rectal Surg. 2019;32(3):196-203.

Varela C, Kim NK. Surgical Treatment of Low-Lying Rectal Cancer: Updates. Ann Coloproctol. 2021;37(6):395-424.

Sripathi S, Khan MI, Patel N, Meda RT, Nuguru SP, Rachakonda S. Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks? Cureus. 2022;14(10):e29964.

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Published

2024-06-27

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Section

Case Reports