Laparoscopic sigmoidectomy postopen aortic replacement for abdominal aortic aneurysm: a case report.

Area of Science:

• Colorectal Surgery
• Vascular Surgery
• Surgical Oncology

Background:

• Colectomy for colorectal cancer following open aortic replacement (OAR) for abdominal aortic aneurysms presents significant perioperative risks.
• Intra-abdominal adhesions from OAR can complicate sigmoid mesocolon mobilization during colectomy.

Observation:

• A case report details an 87-year-old male with sigmoid colon adenocarcinoma who previously underwent OAR.
• Laparoscopic sigmoidectomy was performed, utilizing the patient's artificial arteries from OAR as surgical landmarks.
• The lateral approach facilitated mobilization, though D1 lymphadenectomy was performed due to difficulty accessing the inferior mesenteric artery root.

Findings:

• Artificial arteries from OAR can be effectively used as landmarks during laparoscopic colectomy.
• Careful preoperative assessment, including computed tomography, is essential to identify these landmarks and surrounding structures.
• Despite technical challenges, laparoscopic surgery offers a magnified view beneficial for identifying critical anatomical references.

Implications:

• This approach may enhance the safety and feasibility of colectomy in patients with a history of OAR.
• Utilizing OAR-related vascular grafts as landmarks can mitigate risks associated with adhesions and complex anatomy.
• Further investigation into standardized techniques for laparoscopic colectomy after OAR is warranted.