Allison J Pang, MSc, MD, FRCSC, Julio Faria, MD, FRCSC, Nancy Morin, MD, FRCSC, Gabriela Ghitulescu, MD, FRCSC, Carol-Ann Vasilevsky, MD, FRCSC, Marylise Boutros, MD, FRCSC. McGill University
Anastomotic strictures are complications of colorectal surgery with an incidence of 3-30% depending on the circumstance of the surgery. The underlying pathophysiology of anastomotic strictures are numerous, and the exact cause is sometimes never known. The more common causes include: ischemia, anastomotic leak, hemorrhage, radiation, and technical factors. The management of rectal anastomotic strictures can be challenging. Normally, a short, low colorectal or coloanal anastomotic stricture can be dilated with Hegar dilators or endoscopic balloon dilatation. However, if the stricture is too tight or too long, a transabdominal strategy is required.
Our video is of a 60-year-old male who had a low anterior resection with diverting loop ileostomy for a locally advanced rectal cancer at an outside institution. He was referred for a tight stricture at his colorectal anastomosis (located 5cm from the anal verge) that was not amenable to any type of dilatation technique. A review of the patient’s history, exam, and imaging confirmed that this was a short stricture that developed in the absence of overt infectious complications. On endoscopy, the lower rectum appeared healthy and pliable. In addition, biopsy of the strictured anastomosis confirmed its benign nature. Thus, we used TES to perform the resection of a strictured anastomosis and to fashion a new end-to-end low colorectal anastomosis. The patient did well post-operatively and avoided an invasive abdominal operation. He will undergo a gastrograffin enema and flexible sigmoidoscopy six weeks after surgery to confirm patency of the anastomosis. He will then be planned for ileostomy closure at 3 months.
TES, regardless of the type of platform used, can offer an excellent view of the rectum and should be considered an important part of a colorectal surgeon’s armamentarium of techniques. Although transanal surgery was originally developed for the resection of early rectal tumors, its use has greatly expanded. TES is a creative and feasible minimally-invasive option for the resection and reconstruction of a short colorectal anastomotic stricture.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92342
Program Number: V020
Presentation Session: Colorectal Videos I
Presentation Type: Video