title: Stenosis of a colorectal anastomosis solved by transanal endoscopic microsurgery combined with laparoscopy.
abstract: OBJECTIVE
  The objective of this case report is to present a minimally invasive technique for solving an anastomotic colorectal stenosis using Transanal Endoscopic Microsurgery (T.E.M.) in combination with laparoscopy.
  
  
  CONCLUSIONS
  Often a re-intervention is indicated for the resolution of an anastomotic (sub-) obstruction. This re-intervention is associated with the morbidity and mortality of a laparotomy and a prolonged hospital stay. In the case here presented, a 68-year-old man underwent a laparoscopic rectosigmoid resection for a rectal adenocarcinoma. An end-to-end circular stapled colorectal anastomosis was performed. At first without any postoperative problems, the patient presented with a stenosis of the anastomosis 6 months postoperatively. This stenosis did not result in a total obstruction but was sufficiently advanced to cause faecal impaction and discomfort, which was confirmed using a retrograde gastrografine bowel study. Colonoscopic dilatations were insufficient and after several days the patient experienced a recurrence of the original stenosis. A minimally invasive re-intervention with T.E.M. was performed in combination with laparoscopy to solve the stenosis. To our knowledge, this technique has not yet been described.
  
  
  CONCLUSIONS
  In this paper we describe a possible minimally invasive technique to avoid laparotomy after colorectal or colo-anal anastomotic stenosis. Both the duration of the hospital stay and patient morbidity can be reduced in this way.
authors.affiliation: Department of Abdominal Surgery, Monica-Hospital, Campus Middelares, Deurne, Belgium. jderycker@skynet.be
authors.forename: J
authors.initials: J
authors.lastname: de Rycker
authors.forename: S
authors.initials: S
authors.lastname: Pauli
authors.forename: M
authors.initials: M
authors.lastname: Van Cleemput
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D003113:Colonoscopy; D003251:Constriction, Pathologic; D004724:Endoscopy / Q000379:methods*; D005244:Fecal Impaction / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*