Laparoscopic sigma resection/anterior rectal resection

The following are the operational steps of a laparoscopic large intestine or rectal surgery (laparoscopic anterior rectal resection) in the case of high-grade, stenosing diverticular disease at the transition from the S-intestine (large intestine) to the rectum (= at the recto-sigmoid junction) described:

Under undisturbed general anesthesia after sterile washing and covering under antibiotic protection, the umbilicus is entered openly, a pneumoperitoneum is applied and the remaining trocars are placed under view. Position the patient head-down and on the right side.

The greater omentum is now first moved under the liver, thus ectropating the transverse colon, moving the entire small intestine into the right upper abdomen, exposing the inferior mesenteric vein at the lower edge of the pancreas and cutting it with the ligasure. Layer-accurate preparation from medial to lateral while preserving Told's fascia. Now the entire left hemicolon is mobilized up to the left flexure, lyre-shaped incision of the pelvic floor. This is where the bulk of the inflammation shows up. There is also a sigmoid loop that is firmly attached to the bladder, but there is no clear evidence of fistula formation here.

All adhesions are loosened here, distal to the tänienfan in the area of ​​the rectum the wall is now clearly less edematous and less swollen. The fatty tissue is now inconspicuous too, here the rectal wall is placed in a circular manner, cut with the Echelon linear stapler, blue magazine 60 mm, tube resection while preserving the superior rectal artery and the autonomic nerve plexus.

Further dissection in the proximal direction, preserving the left colic artery. Another inspection of the ureter and the arteria and vena testicularis, these are intact. Now the resection limits are determined, cutting the meso at this point with the ligasure, inserting an octoport after minilaparotomy, dissecting the colon, performing the purse-string suture, cutting the colon. Grasp with Ellis clamps and insert the head of the CDH29, knot in and carefully prepare the free end of the colon, relocate it.

Renewed application of the pneumoperitoneum, now the rectal stump is straightened out by my assistant, introduction of the circular stacker, advancement of the spine through the row of staples, connection. Exact checking of the rotation, performing the anastomosis, air sampling, the anastomosis is primarily tight, tension-free and well supplied with blood. Coloscopy: here the anastomosis is inconspicuous, completely without leakage, without any signs of bleeding. Now reduction of the small intestine and the greater omentum. Irrigation, hemostasis, removal of all trocars under vision, draining of the pneumoperitoneum, continuous suture of the minilaparotomy and suture of the 12 trocar site on the right lower abdomen, intracutaneous skin sutures, steristrips, dry bandage.