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 Laparoscopic left hemicolectomy with articulated forceps for colocutaneous fistulizing Crohn disease
Kyong-Min Kangorcid, Heung-Kwon Ohorcid, Ho Yung Leeorcid, Hong-min Ahnorcid, Duck-Woo Kimorcid, Sung-Bum Kangorcid
Annals of Coloproctology 2026;42(2):258-260.
DOI: https://doi.org/10.3393/ac.2025.01382.0197
Published online: April 28, 2026

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to: Heung-Kwon Oh, MD, PhD Department of Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Email: crsohk@gmail.com
• Received: November 15, 2025   • Revised: December 5, 2025   • Accepted: January 20, 2026

© 2026 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Crohn disease (CD) is an inflammatory bowel disease, characterized by chronic inflammation of the gastrointestinal tract that can affect any segment from the stomach to the anus [1–4]. Approximately 60% of patients with CD have colonic involvement; however, colocutaneous fistulizing CD is a rare manifestation that develops in patients with unresolved abscesses [5–8].
A 26-year-old male patient with CD developed an enlarged abscess cavity and an acute inflammatory colocutaneous fistula originating from the proximal sigmoid colon, despite ongoing infliximab therapy. A 2-step surgical approach was planned, consisting of initial surgical drainage, followed by laparoscopic left hemicolectomy 1 week later. The video demonstrates a laparoscopic left hemicolectomy using articulated forceps (ArtiSential, LIVSMED Inc) for colocutaneous fistulizing CD, with preservation of all major vessels (Supplementary Video 1).
After identification of the colocutaneous fistula, articulated forceps were used to provide stable tissue traction during meticulous dissection around the vessels and inflamed tissues. While preserving the inferior mesenteric vein (IMV), the splenic flexure vein was ligated to achieve full mobilization of the splenic flexure. During medial dissection, only the ascending branch of the left colic artery was ligated, with preservation of the inferior mesenteric artery. As the abscess cavity had dried after the previous drainage, the colocutaneous fistula was easily dissected and separated, without spillage of inflammatory material. The colonic segment containing the fistula was resected, followed by an extracorporeal side-to-side anastomosis.
Postoperative recovery was uneventful. The operative time was 140 minutes with an estimated blood loss of 50 mL, and bowel function returned on postoperative day 2. The patient required no stoma formation and was discharged on postoperative day 7 without complications. One readmission occurred 2 months later due to a flare of underlying CD, which was managed medically with ustekinumab. During a 3-year follow-up period, no recurrence of the colocutaneous fistula was observed.
In this procedure, the articulated forceps played a distinct role in enhancing the safety and precision of mesenteric dissection. Conventional laparoscopic graspers allow traction in a single, rigid plane, often resulting in suboptimal traction vectors when dissecting inflamed or fibrotic CD tissue. In contrast, the wrist-like articulation of the forceps enabled multidirectional, fine-tuned countertraction, which improved exposure of the mesenteric vessels and facilitated controlled dissection in narrow planes [9–11]. This was particularly advantageous during preservation of the IMV, where stable and adjustable traction angles minimized tension on the vascular pedicles. Maintaining the IMV ensured appropriate venous drainage of the remaining left-sided colon, reducing the risk of venous congestion and postoperative bowel edema, thereby supporting adequate perfusion and enhancing postoperative recovery [12]. Moreover, the ability to modify traction direction without instrument exchange allowed smoother separation of the adhesions surrounding the fistula tract [9]. These features highlight how articulated traction can enhance visualization, reduce the risk of inadvertent vascular injury, and support meticulous tissue handling in complex fistulizing CD surgery.
Although segmental resection is generally adequate in patients with CD [13], the extent of resection in this case was determined by the patient’s specific anatomy and the size of the fistulizing defect. The colocutaneous fistula originated from the proximal sigmoid colon near the sigmoid-descending junction, and the descending colon measured only about 10 cm. In addition, the fistula opening on the bowel wall was approximately 5 cm in diameter, leaving insufficient healthy bowel for a limited segmental resection with appropriate margins. As a result, removing the entire diseased segment while securing viable margins led to a specimen length corresponding to a left hemicolectomy.
Definitive colectomy is commonly delayed for several weeks after incision and drainage for intra‐abdominal abscesses complicating CD [14], but in this case the operation was performed earlier than usual as the patient exhibited rapid clinical improvement. After drainage, the abscess cavity rapidly decompressed, inflammatory markers normalized, and the patient remained stable without signs of ongoing sepsis. The fistula opening was large and unlikely to resolve spontaneously, raising concern for recurrent abscess formation if surgery were postponed. In addition, delaying surgery would have necessitated extended fasting, posing nutritional and clinical disadvantages.
With appropriate infection control, laparoscopic surgery using articulated forceps can be a safe and feasible option for colocutaneous fistulizing CD.

Ethics statement

This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (No. B-2511-1009-702). Written informed consent for publication of the research details and clinical images was obtained from the patient.

Conflict of interest

Hong-min Ahn is an editorial board member of this journal, but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: KMK, HKO; Investigation: HYL, HA, DWK, SBK; Project administration: HKO; Writing–original draft: KMK, HKO; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Supplementary Video 1.
Laparoscopic left hemicolectomy using articulated forceps for colocutaneous fistulizing Crohn disease.
Supplementary materials are available from https://doi.org/10.3393/ac.2025.01382.0197.
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        Laparoscopic left hemicolectomy with articulated forceps for colocutaneous fistulizing Crohn disease
        Ann Coloproctol. 2026;42(2):258-260.   Published online April 28, 2026
        DOI: https://doi.org/10.3393/ac.2025.01382.0197
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      Laparoscopic left hemicolectomy with articulated forceps for colocutaneous fistulizing Crohn disease
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