EP421 - Adoption Of Intracorporeal Ileorectal Side-To-Side Anastomosis In Robotic Total Abdominal Colectomy

Sunday, May 10, 2026

12:40 PM - 12:45 PM ET

ePoster Presenter(s)

Martin Infante Altamirano, MD (he/him/his)

Medical Doctor
Universidad Peruana de Ciencias Aplicadas (Peruvian University of Applied Sciences)
Universidad Peruana de Ciencias Aplicadas (Peruvian University of Applied Sciences)
Lima, Lima, Peru

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

Author(s)

SK

Saravana Kumar, n/a

Surgery Resident
Valley Health System
Las Vegas, Nevada, United States

Disclosure information not submitted.
AR

Angel J. Rivera Aponte, MD

General and Bariatric Surgeon
Las Vegas Surgery Associates
Las Vegas, Nevada, United States

Disclosure information not submitted.
HL

Henry J. LUJAN, MD, FACS, FASCRS

Program Director, Advanced GI MIS Fellowship
Jackson South Medical Center
Miami, Florida, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Martin Infante Altamirano, n/a: This individual has no financial relationships with ineligible companies.

Purpose/Background: Minimally invasive surgery has been reported to be a safe and feasible approach for total abdominal colectomy (TAC), offering benefits such as reduced length of stay, morbidity, and mortality. Various types of ileorectal anastomoses have been described, including circular stapled end-to-end and side-to-end configurations, which have high anastomotic leak rates (up to 23%). However, intracorporeal side-to-side anastomosis has been insufficiently investigated. The aim of this study was to describe our experience with intracorporeal ileorectal side-to-side anastomosis following robotic TAC.

Methods/Interventions: A retrospective chart review was conducted of seven patients who underwent elective robotic (da Vinci® Xi) TAC with intracorporeal ileorectal side-to-side anastomosis performed by a single colorectal surgeon between May 2023 and September 2025. Demographic, perioperative, and surgical data, as well as short-term complications, were reported.

Results/Outcomes: See Table 1. The mean age was 57.4 years, and the mean BMI was 30.1. Surgical indications included colorectal cancer, polyposis, and recurrent diverticular bleeding. The mean operative time was 347 minutes (249-497). Three patients experienced postoperative complications: one developed a small bowel obstruction, one developed both a small bowel obstruction and an abdominal abscess, and another developed an abdominal abscess. No anastomotic leak was reported. The median length of stay was 9 days (4-18), and there was no 30-day mortality.

Conclusion/Discussion: Intracorporeal ileorectal side-to-side anastomosis appears to be a safe and effective technique following robotic TAC. We believe this approach provides a wider anastomotic lumen with a potentially lower leak rate compared to circular stapled techniques. We hypothesize that circular stapler-related complications may be attributed to the thin ileal wall, which interacts suboptimally with the anvil, and to the presence of crossing staple lines. In contrast, the side-to-side configuration offers a more uniform, well-perfused anastomosis with improved tissue vascularity and the elimination of intersecting staple lines. The robotic platform further facilitates the precise creation of the anastomosis, allowing for meticulous oversewing, reinforcement, and closure of mesenteric defects. Additionally, avoidance of stirrups, circular staplers, and the need for a highly experienced assistant may contribute to decreased operative costs. Larger comparative studies are warranted to evaluate short- and long-term outcomes among different ileorectal anastomotic techniques.

Patients' demographics and surgery data

Patients' demographics and surgery data