title: Ileorectal bypass performed entirely through a transanal route in a porcine model.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES), a new frontier of minimally invasive surgery, uses the body's natural orifices to create an access for surgical procedures. This study aimed to verify the technical feasibility of ileorectal bypass performed entirely through a transanal access.
  
  
  METHODS
  The procedure was performed on 10 domestic pigs, after which they were killed. A transanal endoscopic microsurgery (TEM) device and endoscopic and laparoscopic instruments were used.
  
  
  RESULTS
  The findings demonstrated that an ileorectal bypass through a transanal access is feasible. The principal steps of a standardized transanal procedure are as follows: confirm a rectal perforation above the peritoneal reflection, perform peritoneoscopy using a standard gastroscope, grasp the small bowel with retrieval forceps and pull it through the rectal hole, suture the ileum and the rectum together using a TEM device, open the ileal loop, and perform endoscopic exploration. Satisfactory anastomosis and no signs of procedure-related complications were confirmed by a post procedure laparotomy.
  
  
  CONCLUSIONS
  Ileorectal bypass through a transanal access is technically feasible in a porcine model, and although still at an experimental stage, it could become a surgical option for treating some types of colonic strictures.
authors.affiliation: Surgical Endoscopy Unit, Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy. linopolese@hotmail.com
authors.forename: Lino
authors.initials: L
authors.lastname: Polese
authors.forename: Imerio
authors.initials: I
authors.lastname: Angriman
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.forename: Roberto
authors.initials: R
authors.lastname: Luisetto
authors.forename: Mauro
authors.initials: M
authors.lastname: Frego
authors.forename: Stefano
authors.initials: S
authors.lastname: Merigliano
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Norberto
mesh_terms: D001003:Anal Canal; D000714:Anastomosis, Surgical; D000818:Animals; D003108:Colonic Diseases / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D007082:Ileum / Q000601:surgery*; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D013552:Swine