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ViewAttendees 1

Session: ePoster Monitor 1-Benign Abdominal Disease 3

eP463 - Ileal First Approach (IFT) for Laparoscopic Right Hemicolectomy (RHC) in Ileocecal Koch's (ICT): Evaluation of a New Approach

Sunday, June 2, 2024
4:30 PM – 4:35 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    Author(s)

  • AC

    Abhijit Chandra, MD, MCh

    Head of the department, Surgical gastroenterology
    King George's Medical University
    King George Medical University,KucknowIndia
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

    • Author(s)

  • PR

    Pritheesh Rajan, MS, MCh

    Assistant professor
    King George's Medical University
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

  • DG

    Deeban Ganesan, MD

    Senior Resident
    King George's Medical University
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

  • BS

    Bharat Sangal, DNB, MCh

    Assistant professor
    Uttar Pradesh University of Medical Sciences
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

  • US

    Utkarsh Srivastava, n/a

    Assistant Professor
    Surgical Gastroenterology, King George's Medical University, Lucknow
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

  • AM

    ARUN Manoharan, MS

    Senior Resident
    KING GEORGE MEDICAL UNIVERSITY
    puducherry, Puducherry, India

    Disclosure information not submitted.

  • RJ

    Rohit Jain, MD

    Senior Resident
    King George Medical University
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

  • ST

    Sanjay Kumar Tripathi, Sr., MS/MCh

    Senior Resident
    KGMU
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

    • ePoster Presenter(s)

  • JS

    Julie Nishant Shah, M.S.

    Resident
    King George Medical University
    Ahmedabad, Gujarat, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • DS

    Dhruv Sharma, MBBS, MS

    Senior Resident
    King George Medical University
    Amritsar, Punjab, India

    Disclosure information not submitted.

  • RR

    Ram Raj, MBBS, MS

    Senior resident
    King George’s Medical University
    Lucknow, Uttar Pradesh, India

    Disclosure information not submitted.

Purpose/Background: Laparoscopic right hemicolectomy (RHC) for Ileocaecal tuberculosis (ICT) is often challenging due to inherent adhesions, pulled up caecum, shortened ascending colon, obscured ureteric anatomy. This makes the traditional medial to lateral approach difficult. Our aim was to evaluate the validity of the new -‘Ileal First’- approach (IFT) for RHC in treating ICT.Methods/Interventions: This was a prospective study, conducted at a single tertiary care teaching institution. All patients who underwent the IFT for RHC in ICT from May 2012 to October 2023 were analysed. Standard four port technique was used with additional ports inserted in case of technical difficulties. This surgical technique involves approaching the naïve terminal ileum first, going underneath its mesentery to secure the ileocolic pedicle, then moving below up towards the hepatic flexure. We evaluated intra-operative difficulties and postoperative outcomes of this technique using a standard protocol for all patients. Outcomes analyzed included operative data capturing intra-operative findings, adhesions, duration of surgery, blood loss, difficulty in identifying ureter, need for an extra port and conversion to open surgery amongst others using a standard protocol.Results/Outcomes: 62 patients were enrolled in study using a standard proforma. 6 patients were converted to open surgery and 56 included in the final analysis. Mean duration of surgery was 179 ±12 minutes. Mean intra-operative blood loss was 71 ±11 ml. Intra-operative technical difficulties encountered included adhesions (49/56) , poor delineation of vascular pedicles (44/56) and need for an extra port (45/56). Additional lateral to medial assistance was required in 12 patients . Post operative morbidity (SSI) occurred in 6 patients. No post-operative mortality was observed. This is a single center prospective study with an uncommon disease, with a small sample size and short follow up.Conclusion/

Discussion: Intra-operative difficulties during LRH in patients with ICT are mainly attributable to the adhesions to adjacent structures, poor delineation of vascular pedicles and multiple conglomerate lymph nodes along these pedicles. ‘Ileal first’approach of RHC in ICT provides the technical ease and is a viable minimally invasive option in these patients.