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Totally intra-abdominal laparoscopic ileocolic anastomosis

Authors

Abstract

A stepwise approach to perform a laparoscopic ileocolic anastomosis is shown. The anastomosis is performed totally intra-abdominally, thus avoiding the need to perform a mini-laparotomy.

Classification

tips and tricks

Keywords

totally intra-abdominal, laparoscopy, ileocolic anastomosis

Media type

Duration

03'00''

Publication

2008-10

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E-publication

WeBSurg.com, Oct 2008;8(10).
URL: http://www.websurg.com/doi-vd01en2380.htm

Totally intra-abdominal laparoscopic ileocolic anastomosis

1. Landmark identification and suturing 00'25''

This video shows a totally laparoscopic intraperitoneal isoperistaltic side to side ileocolic mechanical anastomosis. In order to perform this, we identify two landmarks that will help us to perform a better exposure and a perfectly symmetrical anastomosis. The first stitch is placed distally using a 2/0 monofilament suture. We apply caudal traction and proceed to placing the second stitch in the same way, extracorporeally. Both these stitches are always placed on the antimesenteric and extra-mucosal border.

2. Bilateral colotomy 01'03''

We use the monopolar cautery of the new Ligasure device to perform the division at the level of the anterior tenia of the transverse mesocolon. The same procedure is then performed at the anti-mesenteric level of the ileum.

3. Stapling 01'28''

We then introduce a 60mm linear stapler (Endo-GIA) with a blue cartridge. The fixed extremity of the instrument is first introduced at the level of the colon, which later will allow us to introduce the ileum in the flexible arm of the Endo-GIA stapler. We then place the instrument and the small bowel parallel to each other with the help of caudal traction applied through the distal stitch we had placed earlier on. The system is activated and we perform a totally laparoscopic side-to-side isoperistaltic anastomosis. It is very important to perform a visual control of the mechanical suture line in order to avoid any possible complications due to bleedings and to check the quality of the anastomosis.

4. Colotomy closure 02'11''

The intestinal defect will be closed with the help of a 3/0 monofilament suture. We place a first stitch in the cephalad superior extremity, which will allow us to expose this intestinal defect. To facilitate the procedure needed to close the inferior extremity of the intestinal defect, we place a new type of 3/0 monofilament suture on the inferior extremity. In this way we have obtained exposure and, as you can see here, this type of material has allowed us to perform a continuous suture.

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