Total Laparoscopic Right Colectomy with Concurrent Lumbar Hernia Repair

Abstract

Introduction:

A right-side colon cancer combined with a lumbar hernia is an unusual clinical presentation. A laparoscopic approach for both pathologies provides a faster recovery while enhancing the exact anatomical borders of the lumbar hernia defect. ¹ In addition, an intracorporeal laparoscopic anastomosis reduces mesenteric traction, decreases the risk of twisting the ileal mesentery, and accelerates postoperative recovery. ² This video illustrates the case of a 79-year-old man with an ascending colon cancer with a lumbar hernia who received a laparoscopic right colectomy and concurrent lumbar hernia repair.

Methods:

The patient was placed in the supine position with legs apart. Three 5-mm trocars, one 10-mm trocar, and one 12-mm trocar were used. The right colon was mobilized using a caudal-to-cranial approach. The dissection was performed along the avascular plane between Toldt's and Gerota's fascia. After mobilization of the ascending colon, the D3 lymphadenectomy was performed through a central approach. Then, the gastrocolic ligament was divided, followed by mobilization of the hepatic flexure. After the mesocolic excision was completed, the transverse colon was transected 10 cm distal to the tumor, and the terminal ileum was transected 15 cm proximal to the ileocecal valve using linear staplers. A side-to-side anastomosis was performed in an isoperistaltic manner using a 60 mm linear stapler. ³ The enterostomy was closed using a linear stapler. Then, the lumbar hernia defect was closed with a 3-0 V-Loc™ suture in a single layer. Subsequently, a DynaMesh^®-IPOM was secured using a laparoscopic ProTack™. Finally, a 4-cm longitudinal incision was made for specimen extraction.

Results:

The operation time was 2 hours 35 minutes. The estimated blood loss was 40 mL. The patient was discharged on postoperative day 6. The final pathology confirmed a moderately differentiated adenocarcinoma with mesenteric lymph nodes metastases (pT3N2aM0). All surgical margins were negative. The patient will receive eight cycles of XELOX. Since the time of surgery, the patient has undergone one cycle of XELOX. The follow-up CEA level (7.24 μg/L, 1 month after operation) decreased compared to the preoperative value (14.49 μg/L). There was no evidence of a recurrent hernia or mesh infection at 1 month follow-up in clinic. The radiologic assessment will be performed at 3, 6, and 12 months.

Conclusion:

Laparoscopic right colectomy with a concurrent lumbar hernia repair with mesh may be performed safely without the risk of infection or recurrence and excellent oncologic outcomes.

Authors' Contributions:

H.Z. had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: H.Z. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: All authors. Critical revision of the manuscript for important intellectual content: All authors. Supervision: H.Z.

Ethical Approval:

This study was approved by the Ethics Committee of Changzheng Hospital.

No competing financial interests exist

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Runtime of video: 6 mins 25 secs