Anastomotic leakage after laparoscopic single-port sigmoid resection: Combined transanal and transabdominal minimal invasive management

Walter Brunner, MD, MSc, Andrea Rossetti, MD, Larissa Clea Vines, Stephan Andreas Bischofberger, MD. Kantonsspital St. Gallen / Rorscharch – Clinic of Surgery – CH

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 emergency laparotomy; and performing a diverting stoma or a Hartman’s procedure is a common outcome [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 who developed 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 faecal peritonitis. Using a single-port device (SILSTM Port CovidienTM), 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 solid foods were carried out.
At 102 and 112 days a postoperative follow-up rectoscopic exam showed no residual leak nor stricture of the anastomosis, and both patients had a normal rectal function.

Conclusions Combined minimal invasive transabdominal and transanal treatment of an early detected anastomotic leakage is feasible and safe. We present a video of the described hybrid procedure.

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