Caitlyn Braschi, BA1, Patricia Sylla, MD2. 1Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York NY, 2Division of Colorectal Surgery, Icahn School of Medicine at Mount Sinai, New York NY
Introduction: This video demonstrates transanal-assisted takedown of a complex rectovaginal fistula (RVF) and strictured colorectal anastomosis.
Case description: The patient is a 63-year-old female who underwent emergency Hartmann’s procedure for perforated diverticulitis in 2015. Colostomy reversal was complicated by an anastomotic leak requiring transverse loop colostomy. Upon reattempt at reversal, her rectum was critically strictured and an extended left colectomy with stapled end-side colorectal anastomosis was performed. However, the patient developed feculent drainage per vagina post-operatively, prompting referral for a second opinion. Barium enema demonstrated a large rectovaginal fistula tract arising just below the strictured colorectal anastomosis. An anterior rectal defect was palpable 7 centimeters from the anal verge.
Given her history of multiple prior abdominal surgeries and anticipated hostile abdomen, a primary transanal endoscopic approach was used to salvage her failed colorectal anastomosis. The patient underwent transanal endoscopic proctectomy with takedown of the RVF and transvaginal fistula closure. Open abdominal assistance was provided to mobilize the residual colon and perform a re-do colorectal anastomosis with diverting loop ileostomy.
The patient was discharged on postoperative day 7 with an uneventful course. Her ileostomy was closed 8 weeks post-op with complete resolution of her symptoms.
Conclusion: Transanal endoscopic surgery can be used as a primary surgical approach to correct colorectal anastomotic complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84870
Program Number: V134
Presentation Session: Colorectal 2 Session
Presentation Type: Video