monthly focus

surgical intervention video

The pull-through technique used for lower or middle rectal cancer as an alternative to colo-anal anastomoses has reported good results. As an ileostomy might not be necessary for this technique, it might offer a better patient outcome without the problems associated with intestinal stoma. 

Pull-through technique after a mechanical suture failure

Technique de traction ou technique pull-through après échec de suture mécanique

In this educational video, authors show the case of a 59-year-old male patient who was evaluated in September 2021. He had a stenotic lesion at the level of the splenic flexure, 50cm away from the anal verge, diagnosed as an adenocarcinoma after biopsy. He was in good general conditions without any comorbidities. The radiological staging was made thanks to a CT-scan of the chest and abdomen with contrast medium. In addition, a virtual colonoscopy confirmed the lesion at the splenic flexure with perivisceral lymph nodes. A surgical indication was given to remove the splenic flexure. Authors proposed a segmental resection of the splenic flexure with sparing of the inferior mesenteric vein (IMV). 

Resection of the splenic flexure with complete lymph node dissection of the IMV for advanced colon cancer

Résection de l'angle colique gauche avec curage ganglionnaire complet de la veine mésentérique inférieure (VMI) pour cancer du côlon avancé

In this educational video, the authors present the case of a 27-year-old female patient, with a history of severe vertebral deformity (i.e., scoliosis) which required surgical correction using multiple steps. The patient presented with chronic constipation since she was born, and this constipation deteriorated after scoliosis correction. The condition deteriorated up to the absence of any bowel motion save from using enema. The patient complained of recurrent fecal impaction, which required evacuation under anesthesia several times, especially over the past year. There was a history of appendectomy. The colonic transit study showed a left colonic inertia. Manometry showed elevated resting (95mmHg) and squeeze (210mmHg) pressures, inadequate sphincteric relaxation during bearing down (15%), impaired rectal sensations, and delayed rectoanal inhibitory reflex (RAIR). The patient was then submitted for a laparoscopic Deloyers procedure with a Botox injection in the puborectalis muscle. The operative time was 120 minutes. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. The histopathological examination did not reveal any specific pathology. Follow-up was continued for 12 months with statistically significant improvement in both functional and quality of life assessment scores. Average bowel motions were 3 to 4 times per day until the end of the fourth postoperative month, and then declined to 1 to 2 times per day until the end of follow-up. 

Objectives: The Deloyers procedure provides a back-up plan for the management of severe cases of chronic constipation and also gives a clue to a successful low colorectal anastomosis.



Laparoscopic Deloyers procedure, a back-up solution for chronic constipation due to long-segment colonic inertia

Terminal ileitis is the most frequent clinical onset in Crohn’s disease (CD). Treatment of patients with ileocaecal Crohn’s disease is based on medical therapy with biological agents or immunomodulators. However, surgery can offer excellent short-term and long-term results in terms of health-related quality of life. 

Despite all advances in the medical management of Crohn's disease, surgery is almost inevitable during patient lifetime, due to the lack of response to therapy or the development of complications. Over 80% of patients diagnosed with primary ileocolic CD undergo surgical resection within 10 years of their diagnosis. Of these, 30 to 50% will have a symptomatic disease recurrence during the first 5 years and 50 to 80% by 10 years after surgery. 

In this educational video, authors present the case of a patient with an ileocaecal Crohn’s disease, with a thickened and retracted mesentery, complicated by a double fistulization between the terminal ileum and the sigmoid colon. 

A standardized laparoscopic approach can be applied to safely perform this procedure even in complicated and advanced cases, through the isolation and division of the fistula, a medial-to-lateral complete mobilization of the mesentery and its resection with a clip-and-go technique, and intracorporeal anastomosis. 

Laparoscopic ileocaecal resection with intracorporeal anastomosis for Crohn's disease with double ileosigmoid fistula and mesenteric thickening

Résection iléo-cæcale laparoscopique avec anastomose intracorporelle pour maladie de Crohn avec double fistule iléosigmoïdienne et épaississement mésentérique

Mobilisation vidéo endoscopique du muscle gracile

In this educational video, authors demonstrate the video-assisted mobilization of the gracilis muscle for the treatment of vesicorectal fistula. 

Video endoscopic mobilization of the gracilis muscle

Sigmoïdectomie laparoscopique pour cancer du côlon

This is a case of a patient presenting with a sigmoid adenocarcinoma. He was admitted to the emergency room and underwent a laparoscopic rectosigmoidectomy. In this educational video, the authors demonstrate a stepwise standardized medial-to-lateral approach. This standardized procedure has been followed for approximately 20 years in the authors’ hospital. 

Laparoscopic sigmoidectomy for colon cancer

webinar

Sujets d'actualité en chirurgie colorectale : différences entre l'Orient et de l'Occident

Relive the highlights of the latest IRCAD webinar, which took place on April 22, 2022. It was dedicated to hot topics in colorectal surgery, stressing differences between Eastern and Western countries.

Focus on colorectal surgery