| Popis: |
Right hemicolectomy is one of the more common colorectal resections that a majority of surgeons feel comfortable performing laparoscopically. However, there are instances where these cases can be expected to be more technically difficult such as Crohn’s disease (CD) and reoperative surgery. Primary and reoperative surgery for CD can be complicated by the degree of inflammation or friability; the presence of abscess, phlegmon, fistulas; as well as density and extent of adhesions. Both scenarios present unique challenges and require extensive laparoscopic experience and a careful stepwise approach. Despite the inherent complexity, even the most challenging right colon resections can still be approached laparoscopically. While the surgeon may be hesitant to approach these cases laparoscopically, the authors would argue that at least an attempt at laparoscopy is worthwhile and can have important short-term and long-term implications with significant reduction in morbidity. The laparoscopic approach will minimize abdominal wall trauma, decrease pain, shorten the recovery period, minimize postoperative complications, decrease incisional hernia rates, and preserve parts of the abdominal wall that may subsequently be needed later for reoperation and stoma creation. This chapter will focus on surgical techniques during laparoscopic surgery for complicated Crohn’s disease and reoperative surgery. Technical tips and tricks will focus on strategies that can be used during dissection and ileocolonic anastomosis creation. These recommendations are based on our large, laparoscopic operative experience in this complex patient population. |
