MODIFIED PEDICLED ILEAL FLAP RECONSTRUCTION FOR DUODENAL DEFECT AFTER EN-BLOC RESECTION OF RIGHT COLONIC MALIGNANCY
Right-sided Colonic cancer may invade adjacent organs like duodenum and pancreas in less than 10% of the cases requiring En-bloc resection. The resultant defect in cases with duodenal invasion may be large thus raising concerns about secure duodenal repair without complications. We are describing a modification of the pedicled ileal flap for repairing a large duodenal defect following En-bloc extended right hemicolectomy for a hepatic flexure growth with duodenal involvement. The technique entails trimming of ileal flap opening thus avoiding any duodenal deformity and since there is no additional division of the vasa recta hence there is no unnecessary sacrifice of even a centimetre length of the terminal ileum. For patients with right-sided colon cancer with a more than 5 cm lateral duodenal defect post resection PIFR (with trimmed margin) may be considered as a safe option with low morbidity.
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