Laparoscopic Deloyers Procedure as a Salvage Technique for Colorectal Anastomosis: An Alternative to Total Colectomy

Introduction: The Deloyers procedure is a valuable technique used in reconstructing bowel transit following an extended left colectomy, a Hartmann-type colostomy, or repeated colon resections. It enables the creation of a tension-free colorectal or coloanal anastomosis. Case presentation: A 60-year-old female patient presented for consultation regarding the closure of a colostomy. Her medical history included segmental colectomy of the sigmoid and descending colon, resulting in a Hartmann-type colostomy due to complicated diverticulitis. The patient underwent laparoscopic surgery, during which a segment of the transverse colon with a short mesocolon was identified. Due to the complete release of the colon, a colorectal anastomosis could not be performed. As an alternative to preserving the ileocecal valve and achieving a tension-free colorectal anastomosis, the patient underwent the Deloyers procedure. Discussion: The Deloyers procedure involves tension-free anastomosis between the right colon and the rectum or anus. It includes complete mobilization and a 180° counterclockwise rotation of the hepatic angle and the right colon. The right and middle colic vessels are divided, while preserving the ileocolic pedicle and the ileocecal valve, thus avoiding the need for total colectomy and ileorectal anastomosis, which may yield unsatisfactory functional outcomes. Conclusion: The Deloyers procedure represents a viable alternative to ileorectal or ileoanal anastomosis, offering satisfactory functional outcomes.

Introducción: el procedimiento de Deloyers es una técnica útil en la reconstrucción del tránsito intestinal posterior a una colectomía izquierda ampliada, colostomía tipo Hartmann o resecciones colónicas iterativas, pues asegura una anastomosis colorrectal o coloanal sin tensión. Presentación del caso: una mujer de 60 años acudió a consulta para el cierre de una colostomía, con antecedente de colectomía segmentaria del sigmoides y colon descendente derivada con colostomía tipo Hartmann por diverticulitis complicada. Fue llevada a cirugía laparoscópica, en la que se encontró un segmento de colon transverso con meso corto y al liberarse completamente no se logró realizar la anastomosis colorrectal, por lo que se decidió realizar el procedimiento de Deloyers como alternativa para conservar la válvula ileocecal y obtener la anastomosis colorrectal libre de tensión. Discusión: el procedimiento de Deloyers consiste en la unión del colon derecho y recto o ano libre de tensión después de realizar la movilización completa y rotación de 180° en sentido antihorario del ángulo hepático y el colon derecho, en el que se seccionan los vasos cólicos derecho y medio, con preservación del pedículo ileocólico y la válvula ileocecal, para evitar la necesidad de una colectomía total y una anastomosis ileorrectal, para la cual los resultados funcionales pueden ser insatisfactorios. Conclusión: el procedimiento de Deloyers es una alternativa viable a la anastomosis ileorrectal o ileoanal con resultados funcionales satisfactorios.

Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Cirugía para enfermedad colorrectal vía laparoscópica por el servicio de coloproctología del Hospital Militar Central (2005-2015) / Laparoscopic Surgery for Colorectal Disease by the Coloproctology Service of the Hospital Militar Central (2005-2015)

Resumen Introducción: para el tratamiento quirúrgico de la enfermedad colorrectal se han establecido diferentes abordajes. En los últimos 30 años, la evidencia ha demostrado mayores beneficios en las técnicas laparoscópicas (frente a laparotomía), que dependen directamente del entrenamiento continuo y del criterio práctico de los cirujanos coloproctólogos. Objetivo: caracterizar clínica y quirúrgicamente pacientes sometidos a cirugía laparoscópica colorrectal por el servicio de coloproctología del Hospital Militar Central de la ciudad de Bogotá entre los años 2005 y 2015. Metodología: estudio de corte transversal retrospectivo. Resultados: las características demográficas (clínicas y prequirúrgicas) de los pacientes y sus enfermedades, tiempos, tasas de conversión, complicaciones y perfil de recuperación presentes en los pacientes intervenidos en este lapso por el servicio de coloproctología del Hospital Militar Central de la ciudad de Bogotá fueron similares a los reportados por los servicios coloproctológicos de mayor recorrido a nivel mundial. Conclusiones: aunque el desempeño de nuestro equipo de trabajo solo recoge información relacionada con los últimos 10 años quirúrgicos, los mismos nos ponen al nivel de centros de excelencia en el manejo de la enfermedad colorrectal a nivel mundial.

Abstract Introduction: Various surgical approaches have been established to treat colorectal disease, but in the last 30 years the evidence has shown that laparoscopic techniques produce greater benefits than do laparotomies. This depends directly on continuous training and the practical criteria of colorectal surgeons. Objective: This study clinically and surgically characterized patients undergoing colorectal laparoscopic surgery by the Coloproctology Service of the Hospital Militar Central in Bogotá between 2005 and 2015. Methodology: This is a retrospective, cross-sectional study. Results: Patients' demographic characteristics (clinical and pre-surgery), diseases, times, conversion rates, complications and recovery profiles during the study period were recorded by the Coloproctology service and were similar to those reported elsewhere in the world. Conclusions: Although we only collected information related to the last ten years of surgery, this data puts us at the level of centers of excellence in the management of colorectal disease worldwide.