V17 - Expanding Robotic Applications: Deloyers Procedure for Challenging Colorectal Anastomoses

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Brooklyn Williams, DO (she/her/hers)

Resident
Madigan Army Medical Center
Madigan Army Medical Center
Lakewood, WA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

Scott H. Nguyen, MD

Staff Colorectal Surgeon
Madigan Army Medical Center
OHSU
Lacey, Washington, United States

Disclosure information not submitted.

Senior Author(s)

PP

Poya Pourghaderi, DO

Colorectal surgeon
MultiCare Hosital
Gig Harbor, Washington, United States

Disclosure information not submitted.

Author(s)

CB

Charles A. Baldi, III, MD

Colon and Rectal Surgeon
MultiCare Cancer Institute
Tacoma, Washington, United States

Disclosure information not submitted.
Alison Wenholz, MD

Colorectal Surgery Fellow
MultiCare Health
Tacoma, Washington, United States

Disclosure information not submitted.
CK

Callan Kosnik, PA-C

APP
Multicare
Tacoma, Washington, United States

Disclosure information not submitted.
GV

Gabriela Vargas, MD

Surgeon
Multicare Health Care
Seattle, Washington, United States

Disclosure information not submitted.

CME Eligible

Purpose/Background: The Deloyers procedure allows for tension free colorectal anastomosis by rotating the right colon counterclockwise on the ileocolic pedicle to reach the pelvis. While traditionally performed in open surgery, its application in re-operative, complex colorectal cases using a robotic platform is less frequently described. We present a case demonstrating the use of a robotic Deloyers procedure to restore bowel continuity in a patient with multiple prior abdominal surgeries and significant anatomic disruption.

Methods/Interventions: A 37-year-old male with a history of recurrent diverticulitis underwent low anterior resection at an outside hospital, complicated by postoperative leak requiring exploratory laparotomy, left colectomy, and end colostomy. Subsequent colostomy ischemia necessitated revision, which was further complicated by stoma retraction and three enterocutaneous fistulas. Six months later, he was referred to our colorectal service for reconstruction. Operative steps included extensive adhesiolysis, takedown of the retracted colostomy and enterocutaneous fistulas, rectal stump mobilization with ureterolysis, right colon mobilization, skeletonization of the ileocolic pedicle, and counterclockwise rotation of the right and transverse colon along this axis. Indocyanine green (ICG) angiography confirmed perfusion prior to colorectal anastomosis.

Results/Outcomes: A tension-free, side-to-end colorectal anastomosis was created between the proximal transverse colon and rectum using a 29 mm EEA stapler. Leak testing was negative. The patient tolerated the procedure well, had return of bowel function, and was discharged on postoperative day two. At two weeks, he was recovering well with appropriate wound healing.

Conclusion/Discussion: This case highlights the utility of the robotic platform to safely perform the Deloyers procedure in complex, re-operative scenarios. The enhanced dexterity and visualization of the robotic platform facilitate meticulous vascular dissection and controlled colon mobilization, enabling tension-free anastomosis and expanding the role of minimally invasive techniques in complex colorectal reconstruction.