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Single port laparoscopic-assisted ileocolic resection for recurrent Crohn's disease
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.
F Narouz, R Cahill
Surgical intervention
5 years ago
2329 views
45 likes
0 comments
12:34
Single port laparoscopic-assisted ileocolic resection for recurrent Crohn's disease
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.
Redo management of Crohn's disease after ileocaecal resection 20 years ago: new ileocolic laparoscopic resection
Crohn’s disease is an evolutive inflammatory bowel disease. Surgery may be performed several times during the patient’s life. Using a laparoscopic approach limits the risk of adhesions and the possibilities of re-operations in those patients.
In this film, the surgeon comes across difficulties due to postoperative adhesions and the interest of using new energy devices such as the LigaSure™ blunt tip device and the Sonicision™ cordless ultrasonic dissection device to free the small bowel and divide the mesos with an easy and secure hemostasis.
Concerning the anastomosis between the small bowel and the colon, the use of the new generation of staples manufactured by Covidien is extremely worthy of interest because of the ergonomics of the new handle and the perfect closure and hemostasis of the stapling line of the Tri-staple™ cartridge technology.
J Leroy, J Marescaux
Surgical intervention
7 years ago
1363 views
9 likes
0 comments
16:40
Redo management of Crohn's disease after ileocaecal resection 20 years ago: new ileocolic laparoscopic resection
Crohn’s disease is an evolutive inflammatory bowel disease. Surgery may be performed several times during the patient’s life. Using a laparoscopic approach limits the risk of adhesions and the possibilities of re-operations in those patients.
In this film, the surgeon comes across difficulties due to postoperative adhesions and the interest of using new energy devices such as the LigaSure™ blunt tip device and the Sonicision™ cordless ultrasonic dissection device to free the small bowel and divide the mesos with an easy and secure hemostasis.
Concerning the anastomosis between the small bowel and the colon, the use of the new generation of staples manufactured by Covidien is extremely worthy of interest because of the ergonomics of the new handle and the perfect closure and hemostasis of the stapling line of the Tri-staple™ cartridge technology.