ASCRS U | Laparoscopic Low Anterior Resection

Laparoscopic Low Anterior Resection

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Laparoscopic Low Anterior Resection
- Video Summary
- Video
- Teaching Points
Medial-to-Lateral Approach to the Laparoscopic Low Anterior Resection
- Video Summary
- Video
- Teaching Points
Malignancy
- A 48-year-old otherwise healthy woman has undergone a laparoscopic low anterior resection (LAR) and completed 12 cycles of adjuvant FOLFOX for a near-obstructing pT3N2M0 rectosigmoid cancer. On surveillance imaging, she is found to have a peripheral solitary 3-cm right lower lobe lung lesion. No other metastasis is identified. What is the best next step in her management?
- A perimenopausal female patient with a microsatellite stable rectosigmoid cancer is scheduled for a laparoscopic low anterior resection (LAR). Prophylactic oophorectomy is recommended in which of the following patient scenarios?
- You are counseling a 48-year-old man on laparoscopic low anterior resection for T2N0 rectal cancer, as shown on magnetic resonance imaging (MRI). He asks about possible risks of surgery. Which of the following nerves can be injured during high ligation of the inferior mesenteric artery (IMA)?
Malignancy
- A 65-year-old woman with diabetes is diagnosed with rectal cancer. After receiving neoadjuvant chemoradiation, she undergoes a laparoscopic low anterior resection and 4 of 13 nodes were found to be positive for disease. She undergoes 8 cycles of treatment with FOLFOX (folinic acid, fluorouracil, and oxaliplatin). At her 6-month follow-up visit, she reports numbness, paresthesia, and occasional pain in her toes bilaterally. What is the most likely cause of her symptoms?
Colorectal Cancer: Minimally Invasive Surgery
- Minimally Invasive Rectal Cancer Surgery
- Hand-Assisted Rectal Cancer Surgery
- References
Perioperative
- A 50-year-old man undergoes low anterior resection for rectal cancer. Five days later he developed focal pelvic discomfort without generalized abdominal pain, fevers of 102 °C, and a leukocytosis count of 18,000. His blood pressure is 118/72 mmHg and his heart rate is 112. Computed tomography (CT) with rectal contrast confirms an anastomotic leak with a 6-cm abscess with contrast extravasation. What is the best next step?
Indications for Fecal Diversion
- References
Proctectomy for Rectal Cancer
- References
- Operative Approaches
Bowel Transection and Anastomosis
- References
Anastomotic Construction
- Fundamental Principles for Anastomotic Construction
- References
Benign Disease
- A 54-year-old woman with a history of endometriosis is referred to you for worsening constipation, bloating, and pelvic pain. She previously underwent a laparoscopic-assisted hysterectomy with bilateral salpingo-oophorectomy. You perform a colonoscopy and identify a stricture at the rectosigmoid; the rest of her colon was normal. Pelvic magenetic resonance imaging (MRI) shows irregular thickness with three large spiculated nodules that were hypointense on T1- and T2-weighted images, encasing 70% of the wall of the rectosigmoid, consistent with endometriosis. What is the best surgical option for this patient?
Inferior Mesenteric Artery
- References
Anastomotic Complications
- Anastomotic Leak
- References
Anastomotic Complications
- Anastomotic Stricture
- References
Indications for LAR Versus Intersphincteric Resection Versus APR
- References
Rectal Prolapse
- Abdominal Repairs
High ligation of the middle colic
- Moderator Bios
Parastomal hernia repair
- Moderator Bios
Intestinal Stomas
- References
- Stoma Reversal
Robotic Low Anterior Resection
- Teaching Points
Management of Rectal Cancer (2020)
- TREATMENT
- References
Perioperative
- While performing a low-anterior resection for rectal cancer, you identify a transection of the left ureter in the region of the lateral rectal ligament. What is the best method to repair this injury?
Pelvic Floor
- A 75-year-old woman with chronic rectal prolapse wishes to discuss surgical treatment planning. She has prolapsing tissue with defecation, which is lifestyle limiting due to bleeding, fecal smearing, and pain. On physical examination, she has a 1.5-cm segment of circumferential prolapsing rectal mucosa with a focal anterior ulcer, no rectocele, and moderate baseline tone. She is frail, with a medical history significant for coronary artery disease after stent placement, receives dual antiplatelet therapy, and has a caretaker to assist with daily activities. What is the best surgical approach for repair of this patient’s prolapse?
Ostomy Surgery (2022)
- OSTOMY CLOSURE
- References
Endometriosis
- Treatment
Middle and Anterior Pelvic Compartment: Issues for the Colorectal Surgeon
- Indications and Outcomes for Common Nonoperative and Operative Approaches for Anterior and Middle Compartment Prolapse
Management of Local Recurrences
Management of Rectal Cancer 2023 Supplement (2023)
- References
- Induction Versus Consolidation TNT
Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction (2021)
- SIGMOID VOLVULUS
Enhanced Recovery After Colon and Rectal Surgery from ASCRS and SAGES (2023)
- References
Colonic Diverticular Disease
- References
Rectovaginal Fistula
- References
Evaluation and Management of Chronic Constipation (2024)
- References
Ulcerative Colitis: Surgical Management
- Surgical Options and Postoperative Outcomes
Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery (2022)
- MATERIALS AND METHODS
- References
Use of Bowel Preparation in Elective Colon and Rectal Surgery (2019)
- BOWEL PREPARATIONS
Colorectal Cancer: Preoperative Evaluation and Staging
- References
Optimizing Outcomes with Enhanced Recovery
- References
Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula (2022)
- References
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