• Avanish Saklani, Nader Naguib, Nicola Tanner, Stephanie Moorhouse, Clare Elizabeth Davies, and Ashraf G Masoud.
• Colorectal Surgery Department, Prince Charles Hospital, Merthyr Tydfil, United Kingdom.
• J Laparoendosc Adv Surg Tech A. 2012 Jun 1;22(5):496-500.

PurposeLaparoscopic colorectal surgery creates fewer adhesions compared with open colorectal resection. Small bowel obstruction after laparoscopic colorectal resection may be caused by internal herniation of the small bowel through a colomesenteric defect, probably related to a lack of adhesion formation. This is seen especially after left colonic resections.MethodsA literature review was conducted using the key words "intestinal obstruction" and "laparoscopic left colonic resection," and 9 documented case reports of obstruction following laparoscopic left colorectal resection were identified. We present 2 additional cases and discuss the etiology, diagnosis, management, and possible options for avoiding this complication.ResultsIn total, 167 consecutive laparoscopic procedures were performed in our study, and 8 were left hemicolectomies. Four of these patients (50%) developed intestinal obstruction, with 2 requiring surgical intervention for internal hernia. For the remaining 159 colorectal procedures, there were only 2 admissions with intestinal obstruction, with 1 patient requiring surgery (P = .006).ConclusionsLaparoscopic left hemicolectomy carries a significant risk of internal herniation. Performing a laparoscopic subtotal colectomy or fashioning the colocolonic anastomosis through the small bowel mesentery may minimize this risk.

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