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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 1/2018

01-01-2018 | Short Communication

A surgical solution to regain bowel continuity following an extended left colectomy—reviving and extending the indication for a “Flip-Flop” procedure

Authors: Ronen Ghinea, Shmuel Avital, Ephraim Katz, Baruch Shpitz, Ian White

Published in: International Journal of Colorectal Disease | Issue 1/2018

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Abstract

Background and aims

Extended left hemicolectomy might be necessary for several indications. Once the resection is completed, it would be difficult or impossible to anastomose the transverse colon to the rectum due to the difficulty in mobilizing the transverse colon to reach for a tension-free rectal anastomosis. The aim of this report is to present the “Flip-Flop” technique to overcome this challenging situation. The procedure is based on a surgical technique published in the early 1960s to avoid permanent stoma after proctectomy and consists of changing the location of the right colon to reach the rectum.

Methods

Clinical parameters, surgical aspects, and postoperative outcome of patients that underwent the flip-flop procedure following an extended left colectomy in our medical service was reviewed.

Results

Three patients underwent a flip-flop procedure after an extended left colectomy performed for various reasons. The surgical technique is detailed in a step by step manner. Patients had uneventful postoperative recovery with an adequate functional outcome.

Conclusions

We believe that this approach should be revived and be considered also in cases when the full length of the rectum is preserved to avoid ileo-rectal anastomosis or a high-tension colocolonic anastomosis. Popularization of this surgical solution among surgeons is highly important.
Literature
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Metadata
Title
A surgical solution to regain bowel continuity following an extended left colectomy—reviving and extending the indication for a “Flip-Flop” procedure
Authors
Ronen Ghinea
Shmuel Avital
Ephraim Katz
Baruch Shpitz
Ian White
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 1/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-017-2922-5

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