TRANSVERSECTOMY FOR THE TREATMENT OF SUBSTENOSIS IN CROHN'S DISEASE: TECHNICAL ASPECTS

Case Presentation A 42-year-old female patient was diagnosed with Crohn's Disease at the age of 15, with a colonic location and stenosing behavior. She also had arthritis as an extra-intestinal manifestation. Initially, biological treatment with Infliximab was started for 2 years, but due to clinical response loss, the medication was switched to Adalimumab in association with Azathioprine. The patient underwent outpatient follow-up for approximately 8 years without disease exacerbation, when she developed symptoms of subintestinal obstruction, abdominal distension, and tenesmus. In complementary exams for clinical investigation, Entero-Tomography and colonoscopy revealed a lesion in the transverse colon segment, with a fibrotic and stenosing appearance. The patient was considered a candidate for surgical intervention of the stenosis, and a decision was made for a segmental colectomy, with preservation of the ileocecal valve, using the laparoscopic transversectomy technique with a colonic anastomosis.

Objective The purpose of this video is to demonstrate the laparoscopic transversectomy technique, illustrating the step-by-step surgical approach, with the aim of standardizing a complex surgery for the surgeon. The video will demonstrate the approach, including patient positioning, surgical tactics, and postoperative results.

Conclusion The patient had intestinal transit in the second postoperative day but developed post-epidural anesthesia headache as a postoperative complication. An epidural blood patch was indicated by the anesthesiology team to control the symptoms, which delayed her hospital discharge. The patient had a 30-day clinical follow-up, with good food acceptance, daily bowel movements, and no new episodes of subintestinal obstruction. The histopathological exam confirmed stenosis due to Crohn's Disease, without signs of malignancy. The transversectomy technique demonstrated in the video, despite the complexity of the procedure, should be part of the skillset of a colorectal surgeon as an option for cases of segmental colectomy.

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Artikel online veröffentlicht:
25. April 2025