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Laparoscopic evaluation of medial-to-lateral approach of for management of left-sided colon cance

Background To date, there remain limited data supporting either medial or lateral approach for laparoscopic left colectomy; therefore, the purpose of the study was to evaluate the medial approach (MA) in left-sided colonic cancer. Patients and methods A total of 40 patients with nonmetastatic left colonic adenocarcinoma were prospectively subjected to MA laparoscopic colectomy in the Department of Gastrointestinal Surgery, Faculty of Medicine, Alexandria University, Egypt, in the period from July 2017 to July 2019. Data regarding operative time, bleeding, number of lymph nodes dissected, functional recovery (bowel sounds, gases passage intake of liquids and solids), length of hospital stay, and morbidity and mortality rates were all collected and recorded. Results There were 22 males and 18 females. Their ages ranged from 32 to 70 years, with a mean±SD of 55.61±9.78 years. Bleeding per rectum was the most common presentation in 52.5% of patients. A total of 20 (50%) patients underwent left hemicolectomy, nine (22.5%) patients underwent sigmoidectomy, and 11 (27.5%) patients underwent anterior resection. The mean operative time was 227.3±40.3 min, and the mean blood loss was 212.2±101 ml. Anastomotic leak was detected in six (15%) patients, and surgical site infection developed in five (12.5%) patients. Conclusion The medial (artery-first) approach is preferred in patients with left-sided colon cancer undergoing laparoscopic colectomy. We think that stapled reconstruction of colonic continuity decreases the risk of surgical site infection.