How to Do the Open Deloyers Procedure: A Restorative Alternative When the Colon Does Not Reach the Rectum

The Deloyers procedure is a restorative surgical option when remnant colon cannot reach the rectum following an extended left colectomy. It enables reconstruction by mobilizing and rotating the right colon around the ileocolic pedicle to achieve a tension-free colorectal anastomosis, preserving the ileocecal valve and absorptive capacity of the proximal colon. This technical note outlines the open approach, highlighting key steps such as full colonic mobilization, ligation of middle and right colic arteries, and a 180° counterclockwise rotation of the colon. The anastomosis is performed in an isoperistaltic manner, followed by appendectomy and closure of the mesocolic defect. Indications include complex colorectal resections due to cancer, diverticular disease, or trauma where standard anastomosis is not feasible. Functional results are favorable, with most patients reporting 2-4 bowel movements per day, low incontinence rates, and minimal need for antidiarrheals. The reported anastomotic leak rates are < 6% with acceptable morbidity rates. The open Deloyers procedure is a safe and effective option for restoring continuity and preserving function in complex colorectal cases.