Feasibility of the caudal tunneling with lateral colonic attachment preservation procedure in laparoscopic right hemicolectomy for ileocecal tuberculosis: a prospective cohort study.

PURPOSE: Ileocecal tuberculosis (ICT) presents unique surgical challenges due to dense adhesions, distorted anatomy, and inflamed tissue planes. Although laparoscopic right hemicolectomy (LRH) is well established in colonic surgery, its application in ICT remains limited. We evaluated the feasibility and outcomes of the caudal tunneling with lateral colonic attachment preservation (CLAP) procedure, a modified laparoscopic technique designed to facilitate safer dissection in ICT.

METHODS

This single-center prospective cohort study was conducted between May 2016 and October 2023 at King George's Medical University. Fifty-six adult patients with confirmed ICT underwent LRH using the CLAP technique. The procedure begins with retroperitoneal tunneling along Toldt fascia from the terminal ileum while preserving lateral colonic attachments until the final step. Intraoperative variables, perioperative outcomes, and complications were recorded. Patients were followed for 2 years to assess long-term outcomes.

RESULTS

The median age was 38 years, and 64.3% of patients were female. Dense adhesions were noted in 87.5% of cases. The mean operative time was 181 minutes (mean blood loss, 100±20 mL). Conversion to open surgery occurred in 3 patients (5.4%). Additional ports were required in 80.4%. Morbidities included prolonged ileus (10.7%), surgical site infection (5.4%), urinary tract infection (12.5%), and anastomotic leak (1.8%). There was no mortality. At 2-year follow-up, all patients demonstrated symptom resolution and weight gain, with 1 incisional hernia reported.

CONCLUSION

The CLAP technique is a safe and feasible modification of LRH for ICT, enabling controlled retroperitoneal dissection and minimizing operative risk. Larger multicenter comparative studies are warranted.