Retroileal trans-mesenteric colorectal anastomosis

Colorectal anastomosis after extended left colectomies may result difficult, and, sometimes, impossible due to the shortness of the vascular pedicles and the distance between the two ends. Total colectomy with ileo-rectal or ileo-anal anastomosis with sacrifice of healthy colon and ileocaecal valve is usually preferred to overcome this problem. In this manuscript we describe the stepby-step surgical technique of retroileal transmesenteric colorectal anastomosis which can be used as a salvage technique for both open and laparoscopic surgeries. We also discuss the advantages and disadvantages of this approach compared to other techniques. We believe that the widespread of laparoscopic colorectal surgery as well as the raising volume of metachronous colorectal resections will revive this vintage overlooked approach.