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Single port laparoscopic-assisted ileocolic resection for recurrent Crohn's disease
Epublication WebSurg.com, Mar 2014;14(03). URL: http://websurg.com/doi/vd01en4219
Background: Here we demonstrate a single port laparoscopic ileocolic resection technique in a patient with Crohn’s disease and recurrent anastomotic stricturing despite prior ileocaecal resection and medication. Procedure: The procedure is begun with a 3cm transumbilical incision. After safe peritoneal entry, a wound protector-retractor was placed into the wound and then sealed for laparoscopy with a surgical glove port. Thereafter, the operation proceeded using a 30-degree high definition laparoscope with sterile in-line cabling (EndoEYE™, Olympus Corporation) along with other standard, rigid instrumentation (primarily an atraumatic grasper and a LigaSure™ sealer-cutter, Covidien). The strictured anastomotic segment was cleared of an omental adhesion and mobilized laterally. The proximal colon was fully mobilized and the duodenum as well as right gonadal vessels and ureter were clearly preserved. After medialization of the diseased segment, the glove port was removed and the specimen extracted (without further fascial extension) via the single port access site. A side-to-side stapled anastomosis was performed in the usual fashion and re-laparoscopy done after return of the bowel into the peritoneum. Comment: Single port laparoscopic-assisted surgery is applicable to the re-operative setting in selected patients. Its advantages particularly apply to young patients who value body image and reduced scarring.