The transanal approach with laparoscopy or laparotomy for the treatment of rectal strictures in Crohn's disease.
BACKGROUND
Rectal strictures in patients with Crohn's colitis are common and options described for their treatment include direct steroid injection, injection of tumor necrosis factor (TNF) inhibitors, endoscopic balloon dilatation, use of Hegar dilators, stricturoplasty, and proctectomy. Adequate treatment is a challenge, especially with respect to the prevention of stricture recurrence. We present an option for the surgical treatment of these strictures using a transanal resection of the rectum with the addition of laparoscopy or laparotomy.


METHODS
Three patients who had medically refractory or chronic Crohn's colitis with rectal strictures were referred to us after failed medical management, rectal dilation, and balloon dilation of the strictures. In each case, we performed a transanal sphincter preserving dissection in the prone position and used the lithotomy position for intraabdominal mobilization, completion of the rectosigmoid resection, pull-through of the left colon, and coloanal anastomosis.


RESULTS
We resected the rectal strictures transanally in all three cases. One case provided the opportunity to perform a laparoscopy-assisted procedure, whereas the other 2 patients had laparotomy-assisted rectosigmoid resections. We did a coloanal anastomosis in 2 patients with healthy left colon. In the third case, the anal canal was preserved, but the patient was left with a stoma.


CONCLUSIONS
Transanal resection is feasible in the surgical treatment of rectal strictures in patients with Crohn's colitis. It preserves the anal sphincteric mechanism and may help in avoiding a permanent stoma in a subgroup of patients. We found the prone position very helpful in performing the transanal rectal dissection.
Lawal
Taiwo A
TA
Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Frischer
Jason S
JS
Falcone
Richard A
RA
Chatoorgoon
Kaveer
K
Denson
Lee A
LA
Levitt
Marc A
MA
D000293:Adolescent; D001003:Anal Canal; D000714:Anastomosis, Surgical; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D054047:Surgical Stomas; D016896:Treatment Outcome; D055815:Young Adult