[Technique of laparoscopic descendo-rectostomy for reconstruction of intestinal continuity after Hartmann operation]. 1994

R Schmid, and O Schöb, and R Schlumpf, and F Largiadèr
Klinik für Viszeralchirurgie, Universitätsspital Zürich.

Reestablishing bowel continuity subsequent to sigma resection with terminal descendostomy and blind closure of the rectum (Hartmann procedure) by a descendo-rectostomy (DR) is well suited for a laparoscopic approach. One part of the operation is performed extracorporally, and with the laparoscopic operation there is no need to consider radical tumor surgery or staging rules. We demonstrate our techniques for laparoscopic DR. - Operational steps. - A. conventionally: complete dissection of the descendo-stoma, insertion of a 29 or 31 mm circular stapler head secured by a purse string suture and repositioning of the colon into the abdomen; blunt dissection of reachable intra-abdominal adhesions with a finger, and placement of a 10-mm umbilical trocar using palpation; air tight closure of the abdominal wall at the original stoma site. B. laparoscopically: upon creation of a CO2 pneumoperitoneum, placement of two additional 10 mm trocars; adhesiolysis of the pelvis; preparation of the blind rectal stump; transanal insertion of the circular stapler and perforation of the rectal stump; bringing down the proximal colon into the pelvis (possible need to mobilise the splenic flexure); reconnecting the stapler head with the instrument and firing the stapled anastomosis. - The postoperative period was uneventful. Using a laparascopic approach for a DR following Hartmann's procedure is an attractive and viable method to reestablish bowel continuity.

UI MeSH Term Description Entries
D012007 Rectum The distal segment of the LARGE INTESTINE, between the SIGMOID COLON and the ANAL CANAL. Rectums
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D003106 Colon The segment of LARGE INTESTINE between the CECUM and the RECTUM. It includes the ASCENDING COLON; the TRANSVERSE COLON; the DESCENDING COLON; and the SIGMOID COLON. Appendix Epiploica,Taenia Coli,Omental Appendices,Omental Appendix,Appendices, Omental,Appendix, Omental
D003125 Colostomy The surgical construction of an opening between the colon and the surface of the body. Colostomies
D004239 Diverticulitis, Colonic Inflammation of the COLONIC DIVERTICULA, generally with abscess formation and subsequent perforation. Colonic Diverticulitis
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000714 Anastomosis, Surgical Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side. Surgical Anastomosis,Anastomoses, Surgical,Surgical Anastomoses
D013528 Surgical Staplers Fastening devices composed of steel-tantalum alloys used to close operative wounds, especially of the skin, which minimizes infection by not introducing a foreign body that would connect external and internal regions of the body. (From Segen, Current Med Talk, 1995) Stapler, Surgical,Staplers, Surgical,Surgical Stapler
D020706 Laparoscopes ENDOSCOPES for examining the abdominal and pelvic organs in the peritoneal cavity. Celioscopes,Peritoneoscopes,Laparoscope,Celioscope,Peritoneoscope

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