IPEG 2020 TOP ABSTRACT: Robotic Colostomy Takedown in a Pediatric Patient
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More about complicated appendicitis
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What the experts said
Patient is a 14-year-old female who underwent laparotomy for complicated appendicitis
A rectal injury occurred during the appendicitis surgery and a Hartmann's procedure was performed
Patient had an end colostomy for 3 years
Robotic approach was chosen to avoid a subsequent laparotomy
8 millimeter robotic ports were used
Initial pelvic inspection revealed extensive adhesions to the uterus, cecum, and left lateral pelvic sidewall
A long Hartmann's stump had been brought up to the anterior abdominal wall
A nest of twisted colon tethered together with many inner loop adhesions was found
It was difficult to identify the exact location of the original iatrogenic injury because of multiple interloop adhesions
Flexible endoscope passed relatively easily transanally with some extraluminal compression by adhesions
Mucosa of the distal bowel was mostly healthy and pink
Proximally, an area was found that was either diversion colitis or the site of prior injury
Decision was made to perform segmental resection of sigmoid colon to ensure two viable and unobstructed limbs for anastomosis
Vessel sealing device was used to seal and transect the mesentery up to the bowel wall
Sigmoid pedicle was sealed and transected
A single firing with green load stapler was used to transect the remnant sigmoid colon
An isoperistaltic anastomosis was created between sigmoid and rectum
Tacking sutures comprised of 3-0 Vicryl were used, with three separate interrupted sutures to tack the two limbs side by side
Wristed instruments allow more facile suturing, especially in the upper pelvis
Full thickness enterotomies were created with hot shears in sigmoid and rectum
Indocyanine green and firefly mode on the robot were used to assess vascular supply of the anastomosis, showing normal uptake
Common channel was closed with 2-0 barbed monofilament suture in running fashion, creating a double layer closure
Specimen was removed through the former colostomy aperture
Patient passed flatus on postoperative day 2
Patient was discharged home on postoperative day 3
Full bowel function had returned by postoperative day 4