Bach Mai Procedure with Combining Approach and Early Resection of The Terminal Ileum for Total Laparoscopic Right Hemicolectomy: A prospective study

Purpose: Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL) and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure - a novel combining approach and early resection of the terminal ileum. Methods: . The Dissection Stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: (Cranial approach) dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein, then exposed the right gastroepiploic vein and the trunk of Henle; (Medial-to-lateral approach) exposing the surgical axis - the superior mesenteric vascular axis, then early resection of the terminal ileum to open the dissection from the bottom up; (Caudal approach) radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy) and (Lateral-to-medial approach) resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall. Results: . In 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRH D3, CME/CVL based on the novel combining approach and early resection of the terminal ileum. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number was 101. No serious postoperative complications (grade III or higher) neither in-hospital mortality was detected. Conclusion: This novel combining approach and early resection of the terminal ileum is technically feasible and safe for tLRH D3, CME/CVL . Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.