Dear Editor: Hereby, we report two cases of "twist" of the colonic stump recognized intraoperatively after having performed a colorectal anastomosis following a laparoscopic left colectomy. This procedure, which is nowadays rapidly spreading outside reference centers, involves specific maneuvers aimed at limiting the invasiveness of surgery, which may also be responsible for particular periand postoperative complications. In our tertiary care center, with a specific interest in laparoscopic colorectal surgery, two senior surgeons (more than 100 laparoscopic left colectomies performed) experienced such a complication at a 7-yearinterval. Although two cases represent less than 0.5% of all the left laparoscopic colectomies performed, we believe that such an inconvenient may be more common than generally thought, and that our way to manage it (and the tricks we adopted to avoid it thereafter) may be of some interest to International Journal of Colorectal Disease readers. The two patients were a 54-year-old white Caucasian female (body mass index; BMI 23), affected by diverticular disease and a 58-year-old North African male (BMI 29), affected by an adenocarcinoma of the recto-sigmoid junction. In both cases, a classic, six-trocar(peri-umbilical, left flank, right iliac fossa, sub-xiphoid, right hypochondrium, and supra-pubic) laparoscopic left colectomy was planned (in the second case, a laparoscopic proctocolectomy), with the operating surgeon at the right side of the patient. Intraoperatively, after moving the ileal loops proximally, the inferior mesenteric vein was clipped and sectioned. The left flexure of the colon was mobilized and the sigmoid was dissected. The inferior mesenteric artery was sectioned 2 cm from the aorta. The rectum was dissected by harmonic scalpel until the sacral promontory was reached and then sectioned by linear stapler (in the second case, adenocarcinoma of the recto-sigmoid junction, a total mesorectal excision of the upper third of the rectum was performed, and the rectum was sectioned 3 cm under the lower margin of the tumor). In accordance with the most widespread technique of laparoscopy-assisted left colectomy, a Pfannenstiel-type, 8-cm-long laparotomy was performed in order to enable the specimen delivery and the introduction of the anvil of the circular stapler into the colonic stump. After the laparotomy was closed, the colo-rectal anastomosis was performed by circular stapler introduced via the rectum, in a Knight-Griffen fashion. In the first case, the correct alignment of the colonic stump was not checked, whereas, in the second, the presence of redundant ileum and omentum prevented the surgeon from visualizing the proximal part of the descending colon. At laparoscopic exploration after mechanical stapling, a twist of the colonic proximal stump was noticed (270° and 360°, respectively). In both cases, after ensuring the adequate looseness of the anastomosis as well as a good vascularisation of the colonic and rectal stumps, the surgeon decided not to perform any other surgical maneuver. The ileal loops as well as the greater epiploon were gently repositioned in the abdomen. The procedures lasted 151 and 138 min, respectively. Postoperative R. Costi :X. Pouliquen : C. Manceau : B. Vacher :A. Valverde Service de Chirurgie Viscerale, Digestive et Urologique, Hopital Victor Dupouy, Argenteuil, France