eP743 - Salvage Maneuvers Following Left-sided Colorectal Resection: Derotation of the Right Colon

Purpose/Background: Derotation of the right colon (Deloyer’s procedure - DRC) is a salvage maneuver in the setting of insufficient length after left-sided colorectal resection. The aim of this study was to identify the indications for salvage maneuvers and to assess feasibility and patient outcomes.Methods/Interventions: A single institution, retrospective review identifying all patients undergoing colorectal resection performed between January 1, 2012 and August 31, 2022. Patients requiring DRC were identified. Exclusion criteria included those patients without 90 days of follow-up.Results/Outcomes: We identified 2,368 patients that underwent left-sided colorectal resection between 2012 and 2022. Of those, 23 patients (1%) underwent DRC. The median age was 59-years-old (38 to 78 years old) for our population. Median BMI was 29.4 kg/m2 (17 to 49 kg/m2). Table 1 demonstrates the indications for surgery, operative details and post-operative outcomes. DRC was often planned pre-operatively based upon the location of pathology. The indications included colon adenocarcinoma, colonic inertia, Crohn’s colitis with stricture, diverticular disease, as well as for gastrointestinal bleeding with the intention of preserving the ileocecal valve. We identified two anastomotic complications (9%). The patient who underwent a DRC for inertia developed obstipation and anastomotic dehiscence and returned to OR for completion colectomy and end ileostomy. The enterocutanous fistula patient developed an intra-abdominal fluid collection at her anastomosis requiring IR drainage and, ultimately, a diverting loop ileostomy with subsequent reversal. Planned diverting ileostomy occurred in 4 (17%) of DRC patients, and 75% (3/4) had reversal. The one patients without reversal expired at 6 months post-operatively from causes unrelated to their operation. The 90-day mortality rate was 0%.Conclusion/

Discussion: DRC represents a salvage maneuver for anastomotic construction. At our institution, such maneuvers were necessary in 1% of colorectal resections. Anastomotic complications were rare and only one resulted in end stoma creation (4%). This technique enabled anastomotic construction with proximal colon and spared our patients from end stoma or, alternatively, completion colectomy and ileorectal anastomosis. This series is the second largest cohort, to date, among current published literature. Stoma creation is not necessary in the majority of cases and anastomotic complications occur at rates similar to other colorectal anastomoses. This report demonstrates that derotation of the right colon, though uncommon, offers a salvage technical maneuver in patients undergoing left-sided colorectal resection when reach proves difficult.Deloyer Patient Table