How are complications of laparoscopic left hemicolectomy prevented?

Updated: Apr 13, 2020
  • Author: David B Stewart, Sr, MD, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

The keys to prevention of complications include the following:

  • Skeletonizing the IMA, largely mechanically, with a minimum of electrical energy until exposure and isolation of the left ureter before vessel ligation
  • Using body positioning and medial-to-lateral (MTL) mobilization of the sigmoid colon to avoid grasping the colon as much as possible
  • MTL mobilization of the splenic flexure to avoid a splenic capsular injury
  • Using an advanced bipolar device for potentially less thermal injury with pelvic dissection 

A retrospective analysis of 777 patients who underwent laparoscopic left-side colon resections showed that the use of an intraoperative air leak test (ALT) to assess the colorectal anastomosis reduced the rate of postoperative anastomotic leakage. [17] ALT was performed in 398 patients and not performed in the remaining 379. The overall postoperative colorectal anastomosis leakage rate was 4.1%; in the ALT group it was 2.5%, compared with 5.8% in the non-ALT group.


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