Patrick R Reardon, MD, Brian J Dunkin, MD, Eric M Haas, MD, Joanne Chung, MD, Vadim Sherman, MD, Vega Koss, MD, Luis Benavente-Chenals, MD. The Methodist Hospital Department of Surgery Methodist Institute for Technology, Innovation, and Education Houston, Texas 77030
Sigmoid diverticulosis with recurring sigmoid diverticulitis is a common disease entity likely to be treated by general surgeons. The standard surgical therapy involves resection of the involved sigmoid colon with anastomosis of the remaining colon to the rectum. Anastomotic bleeding and anastomotic leak are two of the most common complications of an EEA anastomosis. We present here a novel technique for the treatment of these complications.
Two patients, both with recurrent sigmoid diverticulitis, were treated. The first patient was a 66 year old woman who underwent laparoscopic sigmoid colectomy, mobilization of the splenic flexure, and anastomosis with an EEA stapler. In the immediate postoperative period, she had bright red blood per rectum, and lowered her Hgb to 6.0. The second patient was a 63 year old, morbidly obese woman with a BMI of 38 kg/m-2. During intraoperative proctoscopy she had a stream of bubbles from the posterior anastomosis which stopped, and could not be reproduced. One of the EEA doughnuts was thin.
Both patients were treated by a novel technique. The bleeding anastomosis and incomplete anastomosis were treated by suturing, via transanal video-assisted surgery (TAVAS) utilizing a SILS™ port, to oversew the bleeding artery and incomplete staple line.
Advantages of TAVAS include: 1. Visualization via TAVAS is superior to “conventional” methods of visualization for treating these complications. 2. Insufflation of the colon with CO2 leads to superior distention of the colon with no ill effects noted in our patients. This improves visualization and, in our first case, caused a significant reduction in the rate of bleeding. 3. Laparoscopic skill sets can be utilized by those who are already trained in these techniques. Disadvantages of TAVAS include: 1. The high cost of the SILS™ device. 2. As with all SILS procedures, visualization and suturing are more difficult than with standard laparoscopic technique. For surgeons who have good laparoscopic skills, the use of TAVAS is recommended for the treatment of acute complications of an EEA anastomosis, such as bleeding or leak discovered at the time of surgery.
Program Number: V009