Endoscopy-assisted transanal repair of afferent limb obstruction and long efferent limb with ileopexy after ileal J-pouch-anal anastomosis.
Afferent limb obstruction can be a persistent complication after restorative proctocolectomy with ileal pouch-anal anastomosis. We present a case of afferent limb obstruction complicated by a long efferent limb of the ileal pouch that we successfully treated with side-to-side anastomosis of the afferent and efferent limbs. The procedure involved using a transanal endoscopic stapling device assisted by transanal endoscopy with a thin intestinal video endoscope. This allowed reliable, safe visualization of the lesion from the tight pouch-anal anastomosis and facilitated repair with an endoscopic stapling device. Because the technique was performed without enterotomy, it reduced the risks of contamination and leakage from transabdominal small bowel anastomosis. Laparotomy view also prevented of injury to the pouch itself and entrapment of the mesentery of the afferent and efferent limbs of the pouch between the stapler anvils.
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Toshimitsu
T
Araki
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Yoshiki
Y
Okita
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Mikio
M
Kawamura
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Satoru
S
Kondo
Departments of Innovative Surgery and Surgical Techniques Development, Mie University Graduate School of Medicine, Tsu, Japan.
Minako
M
Kobayashi
Departments of Innovative Surgery and Surgical Techniques Development, Mie University Graduate School of Medicine, Tsu, Japan.
Masaki
M
Ohi
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Yuji
Y
Toiyama
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Koji
K
Tanaka
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Yasuhiro
Y
Inoue
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Keiichi
K
Uchida
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Yasuhiko
Y
Mohri
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.|Departments of Innovative Surgery and Surgical Techniques Development, Mie University Graduate School of Medicine, Tsu, Japan.
Masato
M
Kusunoki
D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D017792:Surgical Stapling; D000067368:Transanal Endoscopic Surgery
Afferent limb obstruction; ileal pouch; ileopexy