1. Transanal Endoscopic Microsurgery: Endoscopy Assisted Treatment of Colorectal Anastomotic Stenosis
- Author
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Stefano Pontone, Antonietta Lamazza, Andrea Picchetto, Giancarlo D'Ambrosio, Antonello Trecca, Cristina Panetta, Rossella Palma, and Emanuele Lezoche
- Subjects
Anastomotic stenosis ,medicine.medical_specialty ,Hirschsprung disease ,medicine.medical_treatment ,Case Report ,Duhamel ,RC799-869 ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Barium enema ,Colotomy ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Endoscopy ,Microsurgery ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Colorectal surgery ,digestive system diseases ,Surgery ,Stenosis ,Contrast medium ,030220 oncology & carcinogenesis ,Transanal endoscopic microsurgery ,030211 gastroenterology & hepatology ,business - Abstract
Transanal endoscopic microsurgery (TEM) is a type of natural orifice transluminal endoscopic surgery, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36-year-old woman with a diagnosis of Hirschsprung disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of preanastomotic colon (proximal colon from the anastomosis) was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM-colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique.
- Published
- 2020