Laparoscopic ileo-cecal resection: the total retro-mesenteric approach

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Laparoscopic ileocecal resection is standard for Crohn's disease.
• Dissection techniques include lateral-to-medial and medial-to-lateral approaches.
• The total retro-mesenteric approach is a novel technique for this procedure.

Purpose of the Study:

• To describe the total retro-mesenteric approach for laparoscopic ileocecal resection in Crohn's disease.
• To evaluate the safety and efficacy of this technique.

Main Methods:

• The technique utilizes four trocars, with a 10- to 12-mm suprapubic trocar for the telescope.
• Dissection begins by creating a retro-mesenteric tunnel, offering visualization of the duodenum, ureter, and gonadic vessels.
• The right colon is detached from the mesentery, allowing for either extra- or endocorporeal anastomosis.

Main Results:

• The retro-mesenteric approach has been employed since 2004, with 89 patients treated by May 2013.
• The mean operative time was 130 minutes.
• The procedure demonstrated a morbidity rate of 6% and a laparoconversion rate of 13.6%.

Conclusions:

• The total retro-mesimetric approach is a safe method for laparoscopic ileocecal resection in Crohn's disease.
• It allows dissection away from inflamed tissues and provides clear identification of anatomical landmarks.
• The morbidity associated with this technique is comparable to other dissection methods.