Published online Nov 28, 2013. doi: 10.5412/wjsp.v3.i3.25
Revised: October 22, 2013
Accepted: November 7, 2013
Published online: November 28, 2013
Colorectal anastomosis after extended left colectomies may result difficult, and, sometimes, impossible due to the shortness of the vascular pedicles and the distance between the two ends. Total colectomy with ileo-rectal or ileo-anal anastomosis with sacrifice of healthy colon and ileocaecal valve is usually preferred to overcome this problem. In this manuscript we describe the step-by-step surgical technique of retroileal transmesenteric colorectal anastomosis which can be used as a salvage technique for both open and laparoscopic surgeries. We also discuss the advantages and disadvantages of this approach compared to other techniques. We believe that the widespread of laparoscopic colorectal surgery as well as the raising volume of metachronous colorectal resections will revive this vintage overlooked approach.
Core tip: Several approaches have been proposed as salvage techniques to avoid total colectomy with ileo-rectal or ileo-anal anastomosis after an extensive mobilization and left colon resection. However, as these techniques, which we are going to discuss hereafter, involve various technical difficulties, we present a valid alternative to ileo-rectal or ileo-anal anastomosis: a retro-ileal, trans-mesenteric colorectal anastomosis, first described by R. Turnbull in 1972, which allows a safe and tension free anastomosis after both open and laparoscopic extended left colon resections with inadequate residual length for standard colo-rectal anastomosis.