- Case Report
- Open Access
Colonoscopy assisted laparoscopic sigmoidectomy: a case report
© licensee BioMed Central Ltd. 2009
Received: 31 March 2009
Accepted: 10 June 2009
Published: 29 June 2009
We report a case of colonoscopy-assisted laparoscopic sigmoidectomy used for the management of sigmoid volvulus.
We report a 68-year-old female who underwent colonoscopy assisted laparoscopic sigmoidectomy. In this procedure, an anvil is inserted into the anus with colonoscopic assistance. An anastomosis is established without removing the colon from the abdominal cavity, and the maximum incision size is approximately 2 cm, similar to that in laparoscopic cholecystectomy. The risk of infection is lower compared with pure laparoscopic surgery, in which an incision is made for extracting the tissue specimen without opening the colon within the abdominal cavity to maintain anastomosis. The patient was discharged 1 week after surgery without complications.
We believe that this new technique is a feasible approach for the treatment of benign lesions, particularly sigmoid volvulus, which is generally large enough to allow insertion of the anvil.
Laparoscopic techniques have become indispensable tools for surgeons. In colonic surgery, laparoscopic procedures are widely performed. Typically, the surgeon withdraws the colon from the abdominal cavity, resects the lesion, attaches an anvil to the oral end of the colon, returns the colon to the abdominal cavity, and then performs an anastomosis of the remaining intestine. This procedure requires an incision larger than 5 cm. Pure laparoscopic anastomosis, in which the colon is not removed from the abdominal cavity, is very difficult to perform. Therefore, laparoscopy often provides no clear advantage over open colectomy. However, in our technique, the maximum incision size is approximately 2 cm, an obvious advantage over classic laparoscopic surgery.
A 68-year-old yellow raced Japanese female had a chronic history of sigmoid volvulus with persistent constipation due to paralysis of the sigmoid colon. Sigmoidectomy is considered the best therapy for such conditions. The possibility of malignancy and other abdominal diseases was eliminated by performing colonoscopy, abdominal computed tomography, and barium enema. The day before the operation we prepared the colon using 1800 ml isotonic magnesium citrate.
Using the technique described here, the size of the operative scar is almost identical to that after laparoscopic cholecystectomy. Benign lesions, sigmoid volvulus, diverticulitis, and inflammatory bowel diseases have been treated with laparoscopic approaches, - but most of these cases were treated by a method identical to that used in malignant cases, in which the colon is anastomosed outside the abdominal cavity. Large incisions are required for this procedure. This new technique seems to be applicable to several diseases, apart from malignancies, where it is impossible to remove the colon without incising the tumor. In addition, anastomoses that require the colon to be opened in the intra-abdominal cavity, such as intra-abdominal functional end-to-end anastomosis, are also performed as colonic anastomoses . However, this necessitates opening the colon in the abdominal cavity, and also requires an additional staple line compared with our method. Therefore, our method is superior to functional end-to-end anastomosis and other anastomoses for the view point of risks of infection and leakage.
Several features of malignant growths, such as their size and location, may restrict the application of the method described here. However, this method is feasible in disease conditions that have a sufficiently large lumen for anvil insertion. And more this technique may be useful for minimum invasive surgery such as "NOTES" in near future.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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