Deloyers procedure compared to ileorectal anastomosis as restoration techniques of bowel continuity after extended left colon resection

Does preservation of the ileocecal valve make a difference? A propensity score matched comparison of Deloyers procedure versus extended right hemicolectomy

BACKGROUND

When performing left hemicolectomies, surgeons might encounter difficulties when restoring bowel continuity. Ileocecal valve resection and performing an ileosigmoid anastomosis is one possible solution. An alternative is preserving the ileocecal valve by counterclockwise rotation of the remaining colon, ensuring a tension-free anastomosis. This study compares functional outcomes after Deloyers procedure and extended right colectomy with an ileosigmoid anastomosis.

METHODS

Between 2008 and 2021, we included patients who underwent Deloyers procedure. Using propensity score matching, controls who underwent extended right hemicolectomy were identified. Perioperative outcomes were compared and patients were questioned using the St. Marks-score and the EORTC-29CR.

RESULTS

We identified 19 patients who underwent the Deloyers procedure and 28 controls. Both groups had comparable mean age (61.4 years, p = 0.3), gender distribution (women: 40%, p = 0.19), ASA classification (p = 0.89) and BMI (26.8 kg/m2, p = 74). Deloyers patients were less often treated for oncologic indications (53% vs. 86%, p = 0.02). Postoperative morbidity (37% vs. 36%, p = 0.99) and mortality (0 vs. 4%, p = 0.99) were similar. Deloyers patients reported worse body perception (83.3 vs. 100, p = 0.02), but frequency of bowel movements (2 vs. 3, p = 0.09) and use of antimotility agents (8% vs. 0%, p = 0.22) were comparable. The overall and individual results of the St. Marks and EORTC QLQ-CR29 questionnaires showed no significant differences (p > 0.05).

CONCLUSION

In our study, patients who underwent Deloyers procedure showed no mortality and comparable morbidity, functional and quality of life outcomes to patients who underwent extended right hemicolectomy.

Deloyers Technique for Restoration of Bowel Continuity Following Extended Left Hemicolectomy: A Comprehensive Analysis of 97 Cases and Literature Review

BACKGROUND

Deloyers technique addresses challenges in restoring bowel continuity after extended left hemicolectomies. Despite being first described in 1958, the technique remains underused, with limited data on long-term outcomes.

OBJECTIVE

To evaluate the indications of surgical and functional outcomes of the Deloyers technique and review existing literature.

DESIGN

Using a prospectively maintained database, patient demographics and perioperative data were collected. A telephone interview was conducted to assess bowel function, and statistical analysis identified factors affecting bowel function.

SETTINGS

Single tertiary care center.

PATIENTS

Patients who underwent the Deloyers technique from January 1995 to February 2023.

RESULTS

A total of 97 patients were included. The most common indications were colorectal cancer (50.5%) and diverticular disease (21.6%). In 53.6% of cases, Deloyers technique was performed at reoperations, and in 70.1% of cases, a diverting loop ileostomy was created. Early surgical complications occurred in 7.2% of patients, including 5 anastomotic leaks, 1 colonic conduit ischemia, and 1 small-bowel obstruction. Late complications occurred in 8.2% of cases, including 6 anastomotic strictures and 2 chronic leaks. There was no perioperative mortality. A total of 40 patients were interviewed and reported an average of 3.5 bowel movements per day and 0.5 at night; 17.5% of patients used bowel stoppers and 52.5% of patients reported that their bowel function did not impact their quality of life. Previous radiotherapy and anastomosis <8 cm from the anal verge were associated with having 4 or more bowel movements per day ( p < 0.01).

MAIN OUTCOME MEASURES

Postoperative morbidity and bowel function.

LIMITATIONS

Retrospective analysis of a heterogeneous group of patients with different pathologies and indications for surgery.

CONCLUSIONS

Deloyers technique is a safe and effective alternative for restoring bowel continuity after extended left hemicolectomy. Postoperative functional results are generally satisfactory, with more favorable outcomes noted in patients with higher anastomoses and those who have not undergone prior pelvic radiotherapy. See Video Abstract .

TCNICA DE DELOYERS PARA LA RECONSTRUCCIN DE LA CONTINUIDAD INTESTINAL TRAS HEMICOLECTOMA IZQUIERDA AMPLIADA ANLISIS EXHAUSTIVO DE CASOS Y REVISIN BIBLIOGRFICA

ANTECEDENTES:La técnica de Deloyers aborda los retos que plantea la reconstrucción de la continuidad intestinal tras hemicolectomías izquierdas ampliadas. A pesar de haber sido descrita inicialmente en 1958, la técnica sigue siendo poco utilizada, con datos limitados sobre sus resultados a largo plazo.OBJETIVO:Evaluar las indicaciones y los resultados tanto quirúrgicos como funcionales de la técnica de Deloyers y revisar la bibliografía existente.DISEÑO:Gracias a una base de datos mantenida de forma prospectiva, se recopiló información demográfica y perioperatoria de los pacientes. Se realizó una entrevista telefónica para evaluar la función intestinal y el análisis estadístico identificó los factores que afectaban a la función intestinal.ENTORNO:Un único centro de atención terciaria.PACIENTES:Aquellos sometidos a técnica de Deloyers entre enero de 1995 y febrero de 2023.RESULTADOS:Se incluyó a un total de 97 pacientes. Las indicaciones más frecuentes fueron cáncer colorrectal (50,5%) y enfermedad diverticular (21,6%). En el 53,6% de los casos se realizó DT en las reoperaciones y en el 70,1% se creó una ileostomía de protección. Se encontraron complicaciones quirúrgicas tempranas en 7,2% de los pacientes, incluidas cinco fugas anastomóticas, una isquemia segmentaria de colon y una obstrucción del intestino delgado. Se describen complicaciones tardías en 8,2% de los pacientes, entre ellas 6 estenosis anastomóticas y 2 fugas crónicas. No hubo mortalidad perioperatoria. Se entrevistó a un total de 40 pacientes, que declararon una media de 3,5 deposiciones al día y 0,5 por la noche; el 17,5% utilizó tapones intestinales y el 52,5% de los pacientes declaró que su función intestinal no repercutía en su calidad de vida. La radioterapia previa y la anastomosis a menos de ocho cm del borde anal fueron asociadas con la evacuación de cuatro o más deposiciones al día ( p < 0,01).MEDIDAS DE RESULTADOS PRINCIPALES:Morbilidad postoperatoria y función intestinal.LIMITACIONES:Análisis retrospectivo de un grupo heterogéneo de pacientes con diferentes patologías e indicaciones quirúrgicas.CONCLUSIÓN:La técnica de Deloyers es una alternativa segura y eficaz para restaurar la continuidad intestinal tras una hemicolectomía izquierda ampliada. Los resultados funcionales postoperatorios son generalmente satisfactorios, observándose resultados más favorables en pacientes con anastomosis más altas y en aquellos que no han recibido radioterapia pélvica previa. (Traducción-Dr. Xavier Delgadillo ).

Colonic Derotation Revisited: The "Deloyers Procedure" for Long-Segment Hirschsprung Disease

Long-segment Hirschsprung disease (HSCR) presents significant challenges in surgical management, often requiring extensive bowel mobilization and creative techniques to achieve tension-free anastomosis. Colonic derotation offers a viable solution for preserving bowel length and maintaining the ileocecal valve, which is crucial for postoperative bowel function. The procedure involves extensive colonic mobilization and strategic vascular divisions of the right and middle colic vessels while preserving the ileocolic and marginal arteries, followed by a 180° counterclockwise rotation of the colon around the ileocolic vascular axis. Critical aspects include ensuring proper bowel orientation post-derotation, the careful assessment of potential compression points, and the preservation of the appendix for potential future antegrade enema conduit creation. The procedure concludes with a transanal pull-through and coloanal anastomosis, achieving optimal bowel positioning without undue tension or laxity. This technique provides a valuable option in the surgical armamentarium for managing complex cases of long-segment Hirschsprung disease.