title: Transanal endoscopic microsurgery approach for rectal stump resection as an alternative to transperitoneal stump resection.
abstract: BACKGROUND
  Transperitoneal rectal stump resection is a complicated procedure with risk of inadvertent bowel, vascular and nerve injury. This study analysed the feasibility and safety of the use of transanal endoscopic microsurgery (TEM) to excise rectal stumps that would otherwise require a combined transabdominal and perineal approach.
  
  
  METHODS
  Rectal stump resection was performed by a transanal approach using TEM. Stumps were removed by complete rectal wall resection and intersphincteric resection of the anus, leaving the mesorectum in place.
  
  
  RESULTS
  The study included nine patients with a rectal stump ranging in length from 8 to 20 cm after previous surgery for inflammatory bowel disease (6), Lynch syndrome (1), collagenous colitis (1) or anastomotic leakage (1). The median duration of operation was 161 (range 107-239) min. The median postoperative length of hospital stay was 5 (range 2-71) days. One patient required an additional small-incision laparotomy to remove a stump extending up to the promontory and another developed a postoperative abscess. There were no perioperative complications.
  
  
  CONCLUSIONS
  TEM appeared to be a useful and safe approach for close rectal dissection and removal of a rectal stump while avoiding an abdominal approach for pelvic dissection.
authors.affiliation: Department of Surgery, Division of Abdominal and Oncological Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. a.bremers@chir.umcn.nl
authors.forename: A J
authors.initials: AJ
authors.lastname: Bremers
authors.forename: K J
authors.initials: KJ
authors.lastname: van Laarhoven
authors.forename: B M
authors.initials: BM
authors.lastname: van der Kolk
authors.forename: J H
authors.initials: JH
authors.lastname: de Wilt
authors.forename: H
authors.initials: H
authors.lastname: van Goor
mesh_terms: D057868:Anastomotic Leak / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D007902:Length of Stay; D008866:Microsurgery / Q000379:methods*; D061646:Operative Time; D011351:Proctoscopy / Q000379:methods*; D012007:Rectum / Q000601:surgery*