Laparoscopic Low Anterior Resection – A Stepwise Approach

Laparoscopic surgery is a technically demanding procedure that requires a significant level of experience and expertise. Since surgery is the mainstay treatment of rectal cancer, comprehending the complexities of multilaminar structures and interfascial spaces is imperative.

This is the case of a 68-year-old woman who was evaluated for a positive fecal occult blood test. Colonoscopy found a vegetative lesion 15 cm from the anal verge, occupying ~1/2 of the lumen. Biopsy and distal tattooing were performed. Pathology study confirmed the presence of a moderately differentiated adenocarcinoma.
The CT-scan showed no lung or liver metastasis. MRI revealed an upper rectal cancer, 11.4 cm from the anal verge, with no pathological lymph nodes, staged as cT2 N0 Mx CRM-.

After discussion in a multidisciplinary meeting, a laparoscopic anterior rectal resection was proposed.

By segmentation of the surgery into well-organized stages, this video demonstrates all the important technical steps to fasten the learning curve and master the procedure without compromising the oncologic principles.

Stapler-assisted Loop Ileostomy Stoma Prolapse Repair

Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Strangulation and ischemia of the prolapsed segment have been reported as complications.

This is the case of a 58-year-old man with multiple comorbidities who was diagnosed with an adenocarcinoma of the ascending colon with hepatic metastasis. He was considered unable to start conversion chemotherapy because of his cardiovascular comorbidities and was therefore under paliative chemotherapy.

Patient came into emergency room with an acute bowel obstruction and underwent a loop ileostomy as a diversion procedure. Following up the procedure, the patient developed an acute on chronic kidney failure because of dehydration from high output ileostomy. In the postoperative day 17, patient presented with an acutely incarcerated prolapsed afferent limb of the loop ileostomy. Attempts at reduction were unsuccessful.

Herein we present a simple, safe, and fast approach for correcting a prolapsed loop or terminal stoma using a step-wise application of linear staplers.

When laparotomy and/or stoma reversal is not appropriate, local revision of stoma prolapse provides a low-risk and high-benefit alternative solution.

Your 30-second teaser has ended. Log in or sign up to watch the full video.

Newsletter Signup

"*" indicates required fields