Diverticulitis: Laparoscopic Assisted Transanal Minimally Invasive Repair of Colorectal Anastomosis

Michael E Dolberg, MD, Jeffrey P Snow, MD, Alejandro Rafuls, ARNP. Memorial Healthcare System

Purpose: This video presents a case of a 55 year old female with a history of diverticulitis and a previous open sigmoid resection. She presented one year after surgery with a perforation at the colorectal anastomosis. This patient was treated with a combination of laparoscopy, TAMIS (Transanal Minimally Invasive Surgery), and colonoscopy to diagnose and treat the anastomotic disruption.

Methods: This patient underwent laparoscopic exploration when she presented with free air under the diaphragm and peritonitis one year after an open sigmoid colectomy for chronic diverticulitis. A laparoscopic washout was performed. The patient was lost to follow up and returned 8 months later with a similar presentation. During the second laparoscopic exploration, she was found to have a long rectal stump with an end-to-side colorectal anastomosis. The defunctionalized rectum contained hard stool that had created ulceration of the bowel wall. TAMIS technique was utilized to revise the narrow and sub-optimally constructed anastomosis.

Results: This patient was successfully treated using minimally invasive techniques during two separate emergent operations. Following the anastomotic revision, a colonoscopy was performed to evaluate the newly constructed side-to-side colorectal anastomosis. The defunctionalized portion of rectum had been completely obliterated. The patient’s constipation, present since her initial open sigmoid resection, had completely resolved.

Conclusions: Laparoscopy is a useful tool in the treatment of complicated diverticulitis. In addition to traditional minimally invasive techniques, TAMIS can also be utilized in the treatment of complex colorectal pathology. Combining laparoscopy and TAMIS allows surgeons to create unique solutions for surgical problems, even in the emergent setting.

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