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Case Reports
. 2024 Jan 10;2024(1):rjad709.
doi: 10.1093/jscr/rjad709. eCollection 2024 Jan.

Robotic low anterior resection with complete splenic flexure mobilization and defunctioning left-sided loop colostomy: a case series

Martin Rutegård  1 , Anders Gerdin  1 , Jannice Forssell  1 , Olle Sjöström  2 , Andreas Söderström  3 , Petrus Vinnars  1
Affiliations
Case Reports

Robotic low anterior resection with complete splenic flexure mobilization and defunctioning left-sided loop colostomy: a case series

Martin Rutegård et al. J Surg Case Rep. .

Abstract

A defunctioning stoma is used to alleviate the consequences of anastomotic leakage after low anterior resection for rectal cancer. A loop ileostomy is often preferred but may lead to dehydration and kidney injury. Here, we present a case series for an alternative: the left-sided loop colostomy. A convenience sample of four patients underwent robotic low anterior resection for rectal cancer. A complete splenic flexure mobilization and a total mesorectal excision were performed. To defunction the anastomosis, the redundant left colon was brought up to a stoma site in the left iliac fossa and matured as a loop colostomy. Two patients experienced minor stoma leaks and one also had a small prolapse, while all patients had their colostomies reversed on average 7 months after surgery without complications. There were no dehydration episodes and creatinine levels remained within baseline levels at end of follow-up (on average 18 months).

Keywords: anastomotic leakage; defunctioning stoma; loop stoma; total mesorectal excision.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Robotic setup.
Figure 2
Figure 2
Complete splenic flexure mobilization and anastomosis.
Figure 3
Figure 3
Testing of colonic length after anastomosis.
Figure 4
Figure 4
Defunctioning left-sided loop colostomy.
See this image and copyright information in PMC

References

    1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 1982;69:613–6. 10.1002/bjs.1800691019. - DOI - PubMed
    1. Borstlap WAA, Westerduin E, Aukema TS, et al. Anastomotic leakage and chronic presacral sinus formation after low anterior resection: results from a large cross-sectional study. Ann Surg 2017;266:870–7. 10.1097/SLA.0000000000002429. - DOI - PubMed
    1. Boström P, Haapamäki MM, Rutegård J, et al. Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer: anastomotic leakage and mortality after anterior resection for rectal cancer. BJS Open 2019;3:106–11. 10.1002/bjs5.50106. - DOI - PMC - PubMed
    1. Emile SH, Khan SM, Garoufalia Z, et al. When is a diverting stoma indicated after low anterior resection? A meta-analysis of randomized trials and meta-regression of the risk factors of leakage and complications in non-diverted patients. J Gastrointest Surg 2022;26:2368–79. 10.1007/s11605-022-05427-5. - DOI - PubMed
    1. Rutegård M, Svensson J, Segelman J, et al. Anastomotic leakage in relation to type of mesorectal excision and defunctioning stoma use in anterior resection for rectal cancer. Dis Colon Rectum 32:1055–9. - PubMed

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