Colorectal anastomosis using retroperitoneal window after wide colorectal resection

After wide colorectal resection, some patients require colostomy due to the difficulty with performing primary colorectal anastomosis. For such patients, we have devised a novel technique of coloproctostomy or coloanal anastomoses through an extra-anatomical route, the retroperitoneal window (RPW), as a reconstruction route. The peritoneum over the inferior margin of the horizontal portion of the duodenum is incised, and the retroperitoneal route is dilated dorsal to the ileocolic artery and vein from the incision below the duodenum towards the right ventral aspect of the aortic bifurcation in the retroperitoneal space. This route is called RPW. After colorectal resection, the proximal stump of the colon is delivered through the RPW, and coloproctostomy or coloanal anastomoses is performed. Nine patients underwent this procedure during a three-year period from December 2007 to November 2010. This technique allowed coloproctostomy was performed in six and coloanal anastomoses in three patients. Without any complications, none of the nine patients required temporary colostomy. By using RPW, the necessity of colostomy would be reduced in patients who require wide colorectal resection.