Surgery for Cancers of the Gastrointestinal Tract by Joseph Kim & Julio Garcia-Aguilar

Author:Joseph Kim & Julio Garcia-Aguilar
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Indications for Operation

Classic indications for right colectomy include cancer or colonoscopically unresectable polyps. Patients with inflammatory bowel disease, specifically terminal ileal Crohn’s disease, are also often candidates for a laparoscopic approach to the right colon. There are certain relative contraindications to attempt laparoscopic resection of the right colon. The size of the incision itself is directly related to the space necessary to remove the specimen. Thus, a bulky specimen often requires a larger midline incision, which often reduces the benefit of a laparoscopic approach. Disease extension into the retroperitoneum or abdominal wall is also a relative contraindication, as oncologic principles of en bloc resection of associated structures must be upheld. Thus, advanced cases should be performed only by laparoscopic colorectal surgeons who are well past their learning curve.

A previous laparotomy is not a contraindication to laparoscopic techniques. Open access to the abdominal cavity utilizing Hasson technique allows for direct visualization prior to trocar placement and insufflation. Adhesions can often be mobilized using electrocautery or alternative energy devices prior to laparoscopic exploration.

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