title: Laparoscopic ileo-cecal resection: the total retro-mesenteric approach.
abstract: BACKGROUND
  Ileo-cecal resection is the most performed procedure in Cohn's disease. In the last decades, the laparoscopic approach became the gold standard. The dissection can be lateral to median or median to lateral. In non-malignant diseases as it is the case for Crohn's disease, the most performed dissection approach is the lateral to median. Herein, we describe a technique performed in our department: the total retro-mesenteric approach.
  
  
  METHODS
  The procedure requires 4 trocars with a 10- to 12-mm median suprapubic trocar. The telescope is placed in this trocar. The dissection will begin with the opening of the mesentery root creating a retro-mesenteric tunnel. This dissection gives a direct visualization of the duodenum, of the ureter and the gonadic vessels which guarantees a safe procedure considering the importance of the inflammation in this disease. At the end of the retro-mesenteric step, the right colon is only attached to the Toldt's fascia. The transection of the mesentery is done next to the bowel wall leaving at the end the choice to the surgeon to perform an extra- or endocorporeal anastomosis.
  
  
  RESULTS
  This retro-mesenteric approach has been used in our department since 2004. Until May 2013, 89 patients underwent laparoscopic resection for Crohn's disease with a mean operative time of 130 min, a morbidity rate of 6 % and a laparoconversion rate of 13.6 %.
  
  
  CONCLUSIONS
  We describe the total retro-mesenteric approach in the ileo-cecal resection for Crohn's disease. The approach is considered to be safe allowing the surgeon to perform a dissection far from the inflammatory site and allowing a visual identification of the duodenum and the right ureter. The morbidity of the procedure is equivalent to the other dissection techniques.
authors.affiliation: Service de chirurgie générale «A», CHU La Rabta, Jbel Lakdher, Bab Saadoun, 1007, Tunis, Tunisie, chebbi_faouzi@yahoo.fr.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Chebbi
authors.forename: M Sofiène
authors.initials: MS
authors.lastname: Ayadi
authors.forename: Rami
authors.initials: R
authors.lastname: Rhaiem
authors.forename: Amine
authors.initials: A
authors.lastname: Daghfous
authors.forename: Amine
authors.initials: A
authors.lastname: Makni
authors.forename: Wael
authors.initials: W
authors.lastname: Rebaϊ
authors.forename: Rachid
authors.initials: R
authors.lastname: Ksantini
authors.forename: Fadhel
authors.initials: F
authors.lastname: Ftirich
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jouini
authors.forename: Montassar
authors.initials: M
authors.lastname: Kacem
authors.forename: Zoubaier
authors.initials: Z
authors.lastname: Ben Safta
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002432:Cecum / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008643:Mesentery / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome