Colonic delta-shaped anastomosis using linear staplers in laparoscopic colectomy

Excerpt

Although laparoscopic surgery has been the standard for colon cancer as a minimally invasive procedure, intestinal anastomosis is often performed extracorporeally, because it is simple and safe. For secure extracorporeal anastomosis (EA), however, wider dissection of the intestine is required and this more extensive dissection is often labor-intensive and time-consuming, especially in obese or transverse colon cancer patients. Excessive traction of the intestine in EA can also cause damage to the intestine or unnecessary bleeding. To alleviate these difficulties, intracorporeal anastomosis (IA) is recognized as a promising option for reducing the surgical invasiveness of the procedure and for minimizing organ damage and excessive bleeding, thereby reducing short-term morbidity [1]. For colon cancers, IA is performed using either a functional end-to-end anastomosis (FEEA) or a side-to-side anastomosis (overlap) approach. On the other hand, IA in laparoscopic distal gastrectomy for gastric cancers is commonly performed using a delta-shaped anastomosis in Billroth-I reconstruction (Delta-G), as first reported by Kanaya et al. [2]. In addition, for the reconstruction of the cervical esophagus and digestive tract, an esophageal delta-shaped anastomosis (Delta-E) has been developed as a new method of stapled anastomosis [3]. With the widespread application of the delta-shaped anastomosis using linear staplers in the reconstruction of the upper digestive tract, we applied this secure and reliable approach to intestinal reconstruction following colon resection. …