title: Intracorporeal anastomoses in emergency laparoscopic colorectal surgery from a series of 59 cases: where and how to do it - a technical note and video.
abstract: OBJECTIVE
  Laparoscopy offers the benefits of minimally invasive surgery and faster recovery. Acute surgical patients may potentially benefit from the great advantages of emergency laparoscopy, which is more clinically relevant in acute than elective patients. Fashioning a laparoscopic intracorporeal anastomosis (ICA) after emergent colorectal resection, whenever technically feasible and not contraindicated by the patient's general and haemodynamic condition, is a most challenging technical skill.
  
  
  METHODS
  During the period 2010-2016, 59 patients underwent a laparoscopic procedure for colorectal emergency in an acute care setting by a single operating surgeon with advanced laparoscopic skills and specific expertise in both colorectal surgery and acute care surgery. This series includes 32 laparoscopic right colectomies (12 for obstruction and 20 for perforation/peritonitis) and 27 left colectomies (6 for obstruction and 21 for perforation/peritonitis). Twenty-eight ileocolic side-to-side ICA, and 27 left colonic ICA (3 colocolic, 24 colorectal) were performed.
  
  
  RESULTS
  Reasonably good postoperative outcomes were observed in the entire series of 59 laparoscopic colectomies performed in an urgent setting. Overall, the major morbidity rate in the entire group was 16.9% (10/59) with an incidence of intra-abdominal abscess of 11.8% (7/59); the overall leak rate was 3.4% (2/59). The re-operation rate was 3.4% (2/59). A video included in the Supporting Information shows five different sites and techniques for ICA and describes technical details with tips and tricks. All patients shown in the video had an uneventful postoperative recovery and were managed postoperatively according to enhanced recovery after surgery protocols.
  
  
  CONCLUSIONS
  This case series illustrates all possible sites and techniques for colonic ICA in an emergency setting. All colorectal and acute care surgeons should have laparoscopic suturing skills.
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Birindelli
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mandrioli
authors.affiliation: General and Emergency Surgery, San Marcellino Hospital, Muravera, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Podda
authors.affiliation: Department of Surgery, Galliera Hospital, Genoa, Italy.
authors.forename: G A
authors.initials: GA
authors.lastname: Binda
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
keywords: Laparoscopy; colorectal surgery; emergency colorectal surgery; intracorporeal anastomosis; laparoscopic anastomosis; laparoscopic colon resection