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Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study.
MedLine Citation:
PMID:  23030665     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aim:  Avoiding "mini-laparotomy" to extract a colectomy specimen may decrease wound complications and further improve recovery after laparoscopic surgery. The aim of this study was to develop a new technique for transrectal specimen extraction (TRSE) and to compare it with conventional laparoscopic colectomy (CL). Method:  Eleven patients with benign disease requiring either sigmoid or left colon resection underwent TRSE. The unfired circular stapler was inserted transanally and used as a guide to suture-close the recto-sigmoid junction laparoscopically and as a handle to pull the sutured sigmoid through the opened rectum inside a laparoscopic camera bag. The anvil was inserted into the lumen of the intussuscepted sigmoid and pushed to the level of the anastomosis. The anastomosis was fashioned end-to-end in the first patients and side-to-end in the following patients to improve safety. Any intra- and post-operative outcome of patients undergoing TRSE was compared with a group of 20 patients undergoing CL, matched for type of resection, BMI and age. Results:  The procedure was successful in all but the first patient who was converted to conventional laparoscopic colectomy without any additional morbidity. Two patients in the end-to-end anastomosis group, but none in the side-to-end group, developed perianastomotic sepsis. Compared to CL, patients undergoing TRSE did not show any significant differences in operative time, recovery or morbidity. Conclusion:  Transrectal specimen extraction after left colectomy using the circular stapler technique is feasible. A side-to-end appears safer than an end-to-end anastomosis. Further studies are needed to explore the potential advantages over CL. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Authors:
Dimitrios Christoforidis; Daniel Clerc; Nicolas Demartines
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-3
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Affiliation:
Department of Visceral Surgery, CHUV, University of Lausanne, Switzerland Department of Surgery, Ospedale Regionale di Lugano, Switzerland.
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