Internal Herniation After Laparoscopic Left Hemicolectomy

Abstract

Small-bowel obstruction after laparoscopic colorectal resection may be caused by internal herniation of the small bowel through a mesenteric defect that is likely related to a lack of postoperative adhesion formation. This is seen particularly after left-sided colonic resections. This article presents the problem of an internal hernia occurring after a classic laparoscopic left hemicolectomy, where the mid-transverse colon is anastomosed to the mid- or proximal sigmoid colon for pathology around the splenic flexure. In this case, approximation and closure of the colonic mesenteric defect are technically difficult, as the duodenal–jejunal flexure will lie above and to the left of the neosplenic flexure. We present two such cases who underwent laparoscopic left hemicolectomy. The first case is a 70-year-old female patient, and the second is 85-year-old female patient. We demonstrate a technique similar to the retrocolic gastrojejunostomy, where a window is created through the small-bowel mesentery for passage of the transverse colon. The transverse colon is anastomosed to the descending colon on the left side of the small-bowel mesentery. This may be performed using an intracorporeal or extracorporeal technique. The edge of the window is sealed around the transverse colon using stitches. This technique may be performed intra- or extracorporeally as shown in the video.

The authors have nothing to disclose.

Runtime of video: 9 mins