Laparoscopic Mesorectal Excision in Obesity: Novel Insights and Technical Strategies.
Dis Colon Rectum
; 62(3): 380-384, 2019 03.
Article
en En
| MEDLINE
| ID: mdl-30741770
ABSTRACT
INTRODUCTION:
Obesity is a burgeoning problem worldwide. Although beneficial in obese patients, conventional laparoscopic mesorectal excision for rectal cancer is technically challenging, with a higher conversion rate to open compared with nonobese patients. We describe novel strategies to circumvent these difficulties. TECHNIQUE The key steps are 1) lateral-to-medial colonic mobilization and left-sided mesorectal excision with the surgeon on the patient's right; 2) switching to the patient's left for right-sided mesorectal excision; 3) further rectal retraction with cotton tape and preperitoneal fat sling; and 4) caudal-to-cephalad mobilization of colon after distal transection, which facilitates extrapelvic mesenteric dissection and vessel ligation.RESULTS:
These techniques optimize gravity to negate the lack of exposure due to visceral obesity. Triangulation is improved by changing the surgeon's position during mesorectal dissection. This allows accurate identification of anatomical planes and avoids excessive pneumoperitoneum pressures and Trendelenburg tilt.CONCLUSIONS:
Adopting these strategies can facilitate laparoscopic mesorectal excision in the obese patient and may reduce conversion to open.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias del Recto
/
Laparoscopía
/
Cirugía Colorrectal
/
Proctectomía
/
Obesidad
Límite:
Humans
Idioma:
En
Revista:
Dis Colon Rectum
Año:
2019
Tipo del documento:
Article
País de afiliación:
Tailandia