Colorectal Surgery
Colorectal Surgery Resident, Hospital General de México; Candidate Member of ASCRS, ESCP and SAGES, Mexico
Complicated acute diverticulitis (Hinchey III and IV) remains a critical challenge in emergency surgery. Despite evidence favoring primary anastomosis over Hartmann’s procedure, the latter remains widely performed due to surgeon experience, hospital resources, and perceived safety. Trials like SCANDIV, DILALA, LOLA, LADIES, and DIVERTI have shaped current management, highlighting benefits such as reduced stoma rates and improved survival with primary anastomosis. Key factors influencing surgical decisions include patient risk assessment, intraoperative conditions, and surgeon expertise. This presentation explores the latest evidence, guideline recommendations, and real-world cases, reinforcing the importance of tailored decision-making to optimize patient outcomes.
Published
Mar 2025
Laparoscopic colorectal surgery has significantly advanced since Hans Christian Jacobaeus performed the first laparoscopy in 1910. In 1991, Jacobs conducted the first laparoscopic colon cancer surgery, marking a milestone in minimally invasive procedures. Despite clear benefits, such as quicker recovery and reduced morbidity, adoption among colorectal surgeons has been gradual due to a steep learning curve (11-117 cases) and limited training opportunities. In the USA, 55-60% of colorectal surgeons use this approach, compared to 70% in Japan. Laparoscopic surgery offers several advantages over open surgery. Key studies, including COLOR, COLOR II, and CLASSIC, have demonstrated similar oncological outcomes, such as disease-free survival and negative resection margins, in both approaches. Patient positioning, particularly the Lloyd-Davis position, is crucial for maximizing surgical reach while minimizing repositioning time and reducing the risk of nerve injury. For right colon surgery, proper trocar placement, vascular structure identification, and an understanding of embryological planes are essential. The adoption of Total Mesorectal Excision (TME) principles and Complete Mesocolic Excision has enhanced oncological outcomes by maintaining peritoneal integrity and performing central vascular ligation.
Published
Sep 2024
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