Abstract
The right gastroepiploic artery (RGEA) is sometimes used for coronary artery bypass grafting (CABG) due to the high patency rate of the graft. Cases of laparoscopy-assisted colectomy (LAC) after CABG using the RGEA are extremely rare. The patient was a 70-year-old male with ascending colon cancer. His history included myocardial infarction at the age of sixty-two, for which he underwent CABG using the RGEA. The patency of the bypass vessels was good in preoperative coronary angiography and celiac angiography. Laparoscopy-assisted colectomy was conducted with standby of a cardiovascular surgeon. Pneumoperitoneum was performed at lower pressure than usual and a beating RGEA was confirmed. We were careful to avoid stress and damage to the RGEA. Laparoscopic right hemicolectomy was conducted without arrhythmia or ST change in an intraoperative electrocardiogram. The important thing in LAC after CABG using the RGEA seemed to be a lower pneumoperitoneum pressure, a patient position, sophisticated surgical technique, and understanding surgical anatomy to conserve the RGEA.
Highlights
The right gastroepiploic artery (RGEA) is sometimes used for coronary artery bypass grafting (CABG) due to the high patency rate of the graft
Laparoscopy-assisted colectomy was conducted with standby of a cardiovascular surgeon
Laparoscopic right hemicolectomy was conducted without arrhythmia or ST change in an intraoperative electrocardiogram
Summary
Upper abdominal surgery is usually performed as open surgery in patients who have undergone coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) as a graft because it is necessary to conserve the RGEA. We describe laparoscopic right hemicolectomy conducted safely in a patient with ascending colon cancer after CABG using the RGEA. He had myocardial infarction at the age of 62 years and underwent CABG (left internal thoracic artery (LITA)—left anterior descending artery, RGEA—right posterior descending coronary artery). The computed tomography colonography showed a tumor of size 20 mm in the ascending colon, but a lesion in the cecum was not detected (Figure 2). Histopathological findings showed that the lesion in the ascending colon was moderately differentiated adenocarcinoma, 14×11 mm, T3, N1 (1/44), lymphatic and venous invasion: positive, and stage IIIB; and that the lesion in the cecum was well-differentiated adenocarcinoma, 26×24 mm (cancer component: 9×3 mm), Tis, N0, lymphatic and venous invasion: negative, and stage 0. The patient was discharged on POD 36 and is currently receiving adjuvant chemotherapy without ECG changes, melena or recurrent cancer
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