Novel technique for anastomotic salvage using transanal minimally invasive surgery:A case report  

作　　者：Oscar A Olavarria Robert L Kress Shinil K Shah Amit K Agarwal 

机构地区：[1]Center for Surgical Trials and Evidence-Based Practice,McGovern Medical School at the University of Texas Health Science Center at Houston,Houston,TX 77033,United States [2]Department of Surgery,McGovern Medical School at the University of Texas Health Science Center Houston,Houston,TX 77033,United States

出　　处：《World Journal of Gastrointestinal Surgery》2019年第5期271-278,共8页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Anastomotic leak(AL) after low anterior resection(LAR) can be a highly morbid complication.The incidence of AL ranges from 5% to 20% depending on patient characteristics and the distance of the anastomosis from the anal verge.Low anastomoses and leaks pose technical challenges for endoscopic treatment.The aim of this report was to describe the use of a commercially available laparoscopic energy device through a transanal minimally invasive surgery(TAMIS) port for the management of a symptomatic leak not requiring relaparotomy(grade B) after a LAR with diverting loop ileostomy.CASE SUMMARY A TAMIS GelPOINT Path port was inserted into the anus to access the distal rectum.Pneumorectum was achieved with AirSeal insufflation and a 30 degree laparoscope was introduced through a trocar.A LigaSure TM Retractable L-Hook device was then used to perform a septotomy of the chronic sinus tract identified posterior to the coloproctostomy.The procedure was then repeated twice in three weeks intervals with ultimate resolution of the chronic leak cavity.Several months after serial TAMIS septotomies,barium enema demonstrated a patent anastomosis with no evidence of persistent leak or stricture.The patient subsequently underwent ileostomy reversal and has had no significant postoperative issues.CONCLUSION TAMIS septotomy with the LigaSure TM Retractable L-Hook is a feasible andeffective,minimally invasive salvage technique for the treatment of grade B ALs.Larger studies are needed to assess the generalizability and long-term results of this technique.Anastomotic leak(AL)after low anterior resection(LAR)can be a highly morbid complication.The incidence of AL ranges from 5%to 20%depending on patient characteristics and the distance of the anastomosis from the anal verge.Low anastomoses and leaks pose technical challenges for endoscopic treatment.The aim of this report was to describe the use of a commercially available laparoscopic energy device through a transanal minimally invasive surgery(TAMIS)port for the management of a symptomatic leak not requiring relaparotomy(grade B)after a LAR with diverting loop ileostomy.CASE SUMMARY A TAMIS GelPOINT Path port was inserted into the anus to access the distal rectum.Pneumorectum was achieved with AirSeal insufflation and a 30 degree laparoscope was introduced through a trocar.A LigaSureTM Retractable L-Hook device was then used to perform a septotomy of the chronic sinus tract identified posterior to the coloproctostomy.The procedure was then repeated twice in three weeks intervals with ultimate resolution of the chronic leak cavity.Several months after serial TAMIS septotomies,barium enema demonstrated a patent anastomosis with no evidence of persistent leak or stricture.The patient subsequently underwent ileostomy reversal and has had no significant postoperative issues.CONCLUSION TAMIS septotomy with the LigaSureTM Retractable L-Hook is a feasible and effective,minimally invasive salvage technique for the treatment of grade B ALs.Larger studies are needed to assess the generalizability and long-term results of this technique.

关 键 词：TRANSANAL MINIMALLY invasive surgery LIGASURE hook Anastomotic LEAK Low ANTERIOR resection Septotomy Case report 

分 类 号：R[医药卫生]