Transanal endoscopic repair of rectal anastomotic defect.
Surgeons often encounter difficulty when constructing a colorectal anastomosis in the "hostile pelvis." Examples include performing low anterior resection or colostomy takedown in the setting of prior radiation, severe inflammation, or a narrow pelvis. Circular staplers have made low anastomosis a viable alternative to permanent colostomy in these situations. However, the surgeon may occasionally be faced with the difficult decision of how to manage a gross disruption of a stapled anastomosis in a pelvis that will not permit anastomotic redo. The traditional approach to this would be creating a permanent colostomy. We describe an alternate approach: endoscopic suturing with protecting ileostomy. We have successfully applied this technique to 4 patients with gross anastomotic disruption in a hostile pelvis. All patients tolerated the procedure well and have maintained normal bowel function without the need for a permanent colostomy.
Machado
Gustavo R
GR
Division of Surgical Oncology, Department of Surgery, Loma Linda University Medical Center and Loma Linda VA Healthcare System, Loma Linda, Calif 92350, USA.
Bojalian
Michael O
MO
Reeves
Mark E
ME
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D013536:Suture Techniques