Karl-Hermann Fuchs, MD, Schulz Thomas, MD, Benjamin Babic, MD, Wolfram Breithaupt, MD, Gabor Varga, MD. AGAPLESION Markus Krankenhaus
Introduction: The purpose of this work was the evaluation of Transanal Hybrid Colon Resections (taCR) for different indications regarding intra- and postoperative problems, results and possible advantages. Transanal Hybrid rectal and colon resections have been introduced in the past years in dedicated centers. The NOTES concept represents the reduction of access trauma and morbidity by using the anus as natural orifice for larger size access and restrict transabdominal access to maximum 3-5 mm instruments.
Methods: After an initial pilot study the indication for taCR was expanded from resection-rectopexy for rectal prolapse to colon resections for slow transit constipation (STC), benign colon stenosis (BCS) and chronic sigmoid diverticulitis (CSD). Selection criteria for performing a taCR rather than traditional laparoscopic colon resection was a BMI < 30, no major previous abdominal surgery, and absence of a large inflammatory mass in diverticulitis. Transanal access was used for all operative steps requiring access of more than 5 mm, such as staplers, large graspers, swaps, specimen retrieval. Data acquisition and analysis was performed for OR-Time, complications, postoperative well being, pain score and quality of life.
Results: Eightytwo patients underwent taCR (33 males, 49 females, median age 58 (24–80)); ta-subtotal colectomy for STC: 7; taCR for BCS: 5; ta-resection-rectopexy: 31; taCR for CSD: 39. conversions: 3 CSD; complications: intraoperative 1 rectal tear; postoperative 3 leaks with revisons. Gastrointestinal Quality of Life Index: pre//post: 87//119; postoperative wound infection: 1 after open revision.
Conclusion: taCR is a safe NOTES Hybrid technique for colorectal procedures, which has been successfully integrated in our operative spectrum and can have the potential in preventing wound and hernia complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79268
Program Number: S043
Presentation Session: Colorectal 1
Presentation Type: Podium