monthly focus

surgical intervention video

In this video, authors demonstrate a laparoscopic Sugarbaker technique for parastomal hernia repair using a Gore-Tex mesh in an 18-year-old man with a history of anal cancer status post-abdominoperineal resection with an end colostomy and known chronic parastomal hernia. His history also includes hypoplastic left heart syndrome status post-orthotopic cardiac transplant, DiGeorge syndrome, Hodgkin’s disease type post-transplant lymphoproliferative disease, and immune deficiency. He presented with abdominal pain, nausea, and vomiting secondary to small bowel obstruction at the site of his previous parastomal hernia. CT-scan showed a mesenteric swirl with a transition point. Upon laparoscopy, the parastomal hernia was identified. The bowel was reduced and hernia edges cauterized. Primary repair of the hernia defect was performed using a percutaneous technique. A Jackson-Pratt (JP) drain was left inside the hernia area and exited through a separate part of the abdomen. Following the Sugarbaker technique, a 16 by 20cm Gore-Tex dual mesh plus was used to reinforce the defect. Percutaneous sutures in the four corners secured the mesh. Once the mesh was in the desired location, absorbable tackers were used to attach the mesh to the anterior abdominal wall. Additional percutaneous sutures were added to the medial mesh. The patient recovered well. His nasogastric tube was removed on postoperative day (POD) 4. He was advanced to a regular diet and discharged on POD 7. Surveillance CT showed an intact repair with no recurrence a year after surgery. This case demonstrates a Sugarbaker technique for the closure of parastomal hernias using a Gore-Tex graft for parastomal hernias. The laparoscopic Sugarbaker technique is a safe procedure for the repair of parastomal hernias. 

Laparoscopic Sugarbaker parastomal hernia repair

Cure laparoscopique de hernie parastomiale de Sugarbaker

video lecture

Excision complète du mésocôlon

In this key lecture, Dr. Armando Melani outlines complete mesocolic excision (CME). 

Complete mesocolic excision (CME)

In this authoritative lecture, Dr. Bill Heald provides key explanations to better understand the splenic flexure of the colon. 

Understanding the splenic flexure

Angle colique gauche : bien le comprendre

Excision totale du mésorectum par voie d'abord laparoscopique

In this key lecture, Dr. Masaaki Ito describes laparoscopic TME. 

Laparoscopic TME

In this key lecture, Dr. Mark Whiteford focuses on the essential anatomy and steps to perform transanal total mesorectal excision (TaTME).

Essential anatomy and steps in performing TaTME

Repères anatomiques essentiels et étapes de réalisation d'un TaTME

In this key lecture, Dr. Eric Rullier outlines the laparoscopic treatment of peritonitis after low anterior resection, providing an interactive case. 

Laparoscopic treatment of peritonitis after low anterior resection (interactive case)

Traitement laparoscopique d'une péritonite après résection antérieure basse (cas interactif)

Colectomie gauche par laparoscopie pour sigmoïdite diverticulaire compliquée récidivante : une procédure didactique en direct

In this live educational video, Dr. Salvador Morales-Conde performs a laparoscopic left colectomy in a 62-year-old male patient with recurrent complicated sigmoid diverticulitis. 

Laparoscopic left colectomy for recurrent complicated sigmoid diverticulitis: a live educational procedure

Professor Morales-Conde demonstrates his technique of laparoscopic sigmoid resection for diverticular disease in a previously heart transplanted patient. In this live educational video, a medial-to-lateral approach is performed. A left colon resection for diverticular disease is performed with splenic flexure mobilization, high ligation of the IMA, and side-to-end anastomosis as a standardized procedure for any benign and malignant left colonic conditions.

During this live operation, the operator interacts with the course audience giving his “tips and tricks” for an outstanding procedure. 

The authors of the video do not have any conflicts of interest or financial ties to disclose.

Laparoscopic sigmoidectomy for diverticular disease: a live educational procedure

Sigmoïdectomie laparoscopique pour pathologies diverticulaires : une procédure didactique en direct

In this live educational procedure, Dr. Armando Melani presents the case of a 70-year-old female patient with a previous history of inferior right lobectomy secondary to T2 carcinoma. In 2018, during postoperative surveillance, PET-scan showed a left colon fixation. Colonoscopy revealed a polypoid lesion located 40cm away from the anal verge. Biopsy showed severe dysplasia. Endoscopic clips were placed for marking purposes. Three additional adenomatous polyps in the right, transverse, and left colon were found and removed. Preoperative abdominal X-ray showed the presence of clips at the level of the left pelvic bone. Since colonoscopy was performed more than two weeks before surgery, intraoperative colonoscopy was used to ensure tumor location. 



During the video, surgical pitfalls were highlighted, and the author showed the importance of preoperative tumor tattooing, demonstrated anatomical landmarks, and the starting point of mesenteric dissection for left colectomy at the superior mesenteric vein (IMV). Recommendations for inferior mesenteric artery (IMA) ligation, hypogastric nerve preservation, splenic flexure mobilization, stapling recommendations during colon transection, colorectal anastomosis, and means to prevent postoperative complications were provided. The value of leak test, endoscopic anastomosis evaluation, and the use of indocyanine green (ICG) were also emphasized.  

3D laparoscopic left colectomy with intraoperative colonoscopy: a live educational procedure

Colectomie gauche laparoscopique 3D avec coloscopie peropératoire : une procédure éducative en direct

An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured. 

The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10. 

Focus on Laparoscopic colorectal surgery