title: Anastomotic leakage after laparoscopic single-port sigmoid resection: combined transanal and transabdominal minimal invasive management.
abstract: BACKGROUND
  Laparoscopic colorectal surgery has become the gold standard in the therapy of benignant and malignant colorectal pathologies. Anastomotic leakage is still a reason for laparotomy; applying a diverting stoma or performing a Hartman's procedure is common [1, 2]. Laparoscopic treatment of an early-detected anastomotic leakage is suggested from other authors [3, 4]. In our video we demonstrate a combined minimal invasive transabdominal and transanal treatment concept in patients with early-detected anastomotic leakage.
  
  
  METHODS
  Two consecutive patients developing an anastomotic leakage after single-port laparoscopic sigmoid resection for stage II/III diverticulitis (Hanson & Stock) were treated with a combined minimal invasive approach. Anastomotic leakage was diagnosed by triple contrast computed tomography on postoperative day 4 in patient one and on postoperative day 7 in patient two. Operative treatment was performed immediately on the same day without delay.
  
  
  RESULTS
  In both patients a combined transanal and transabdominal approach was performed. First step was a diagnostic laparoscopy in order to exclude fecal peritonitis. Using a single-port device (SILS Port Covidien), transanal inspection of the anastomosis was also performed: In both patients anastomotic tissue margins were vital, and the leakage affected only a quarter of the anastomotic circumference. Transanal stitches were placed to close the anastomotic leakage. Laparoscopic transabdominal irrigation was performed, and two suction drainages were placed in the pelvis. Postoperative antibiotic treatment and a gradual return to slid food were carried out. Functional result at follow-up of 102 and 112 days (with rectoscopy) showed no residual leak and no stricture of the anastomosis, and both of patients had a normal rectal function.
authors.affiliation: Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland. walter.brunner@kssg.ch.
authors.forename: Walter
authors.initials: W
authors.lastname: Brunner
authors.affiliation: Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland. andrea.rossetti83@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossetti
authors.affiliation: Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland. larissaclea.vines@kssg.ch.
authors.forename: Larissa Clea
authors.initials: LC
authors.lastname: Vines
authors.affiliation: Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland. nabil.kalak@kssg.ch.
authors.forename: Nabil
authors.initials: N
authors.lastname: Kalak
authors.affiliation: Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland. stephan.bischofberger@kssg.ch.
authors.forename: Stephan Andreas
authors.initials: SA
authors.lastname: Bischofberger
mesh_terms: D000005:Abdomen / Q000601:surgery; D001003:Anal Canal / Q000601:surgery; D057868:Anastomotic Leak / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anastomotic leakage; Colorectal surgery; Laparoscopy; Single-port surgery; TAMIS; Transanal procedure