Anastomotic Leakage of a Colorectal Anastomosis Treated by Transanal Endoscopic Microsurgery

Acta Chir Belg. Jul-Aug 2008;108(4):474-6. doi: 10.1080/00015458.2008.11680269.

Abstract

Objective: To report a minimal invasive technique for repairing an anastomotic leakage with Transanal Endoscopic Microsurgery (T.E.M.) without creating a protective ostomy.

Summary: There are a large number of techniques for the management of anastomotic leakage after colorectal surgery. Depending on the size and location of the disruption, a protective ileostomy, a permanent colostomy or even reintervention for drainage or closure of the leak may be indicated. In most cases the patient faces the morbidity associated with a new intervention, a prolonged hospital stay and a future operation for closure of the stoma. In the present case a 56-year-old man underwent a laparoscopic rectosigmoid resection after two episodes of diverticulitis in six months. An end-to-end circular stapled anastomosis was constructed. Unfortunately 8-days postoperatively an anastomotic leak occurred. Attempts to close the tear non-surgically with colonoscopy and clipping failed. A minimally invasive reintervention with transanal endoscopic microsurgery (T.E.M.) was performed without creation of an ileostomy. One week postoperatively a gastrografin bowel study showed no leakage. To our knowledge, this technique has not yet been reported without the simultaneous construction of a stoma.

Conclusion: We describe a possible minimally invasive technique to avoid laparotomy and/or the creation of a derivative stoma in the management of anastomotic leakage. Hospital stay is not significantly prolonged, future reïntervention for closure of stoma is avoided and sphincter function is preserved.

Publication types

  • Case Reports

MeSH terms

  • Anastomosis, Surgical
  • Colectomy / methods
  • Colon / surgery*
  • Colonoscopy / methods*
  • Diverticulitis, Colonic / surgery*
  • Humans
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / surgery*
  • Rectum / surgery*
  • Reoperation
  • Tomography, X-Ray Computed
  • Treatment Failure