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Surgical Endoscopy

, Volume 32, Issue 11, pp 4472–4480 | Cite as

Combined repeat laparoscopy and transanal endolumenal repair (hybrid approach) in the early management of postoperative colorectal anastomotic leaks: technique and outcomes

  • William Tzu-Liang ChenEmail author
  • Saurabh Bansal
  • Tao-Wei Ke
  • Sheng-Chi Chang
  • Yu-Chun Huang
  • Takashi Kato
  • Hwei-Ming Wang
  • Abe Fingerhut
Article
  • 272 Downloads

Abstract

Background

Few clear recommendations exist for the management of colorectal anastomotic leaks, often based on surgeon preferences or institutional protocols. The primary goal was to evaluate the feasibility and safety of the combined laparoscopic and transanal (hybrid) approach to treat postoperative colorectal anastomotic leaks. The secondary goals included comparison of outcomes following early (< 5 days after initial resection) versus late (≥ 5 days) detection of leaks.

Materials and methods

Sixteen hemodynamically stable patients, with anastomotic dehiscence < 50% of the circumference after laparoscopic anterior resection underwent repeat laparoscopy (lavage/drainage) and transanal endolumenal repair (7 low (< 5 cm from the anal verge) with an ordinary anoscope and 9 high (≥ 5 cm from the anal verge) with a transanal endoscopic operations (TEO®) platform).

Results

The median delay to detection and management was 4.5 days. The procedure was feasible in 13/16 patients (3 patients required conversion to laparotomy). Primary healing of the anastomosis was obtained in 14 patients (13 with the combined procedure, one after conversion). Two patients (1 early, 1 late) sustained persistent purulent discharge via their drain, but the repair healed secondarily. All patients requiring conversion to laparotomy (n = 3) or sustaining intra-operative complications (n = 3) were in the delayed group. No patients required further intervention or died. Protective stomas, created either at index surgery (n = 7) or at re-operation (n = 9), were closed in 14/16 patients within 6 months and no anastomotic sinus, persistent or recurrent fistula, was noted at 1-year follow-up.

Limitations

This is a single-center study consisting of small sample size.

Conclusions

Combined repeat laparoscopy and transanal endolumenal repair is feasible and safe, potentially reducing postoperative morbidity associated with repeat laparotomy and anastomotic leaks. Early detection and re-intervention are fundamental to success. Currently missing from the International Study Group of Rectal Cancer recommendations, laparoscopy and endolumenal repair could be added as a therapeutic option in Grade B.

Keywords

Laparoscopy Anastomotic leak Endolumenal repair Early detection Morbidity 

Notes

Compliance with ethical standards

Disclosures

William Tzu-Liang Chen, Saurabh Bansal, Tao-Wei Ke, Sheng-Chi Chang, Yu-Chun Huang, Takashi Kato, Hwei-Ming Wang, and Abe Fingerhut have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • William Tzu-Liang Chen
    • 1
    Email author
  • Saurabh Bansal
    • 1
  • Tao-Wei Ke
    • 1
  • Sheng-Chi Chang
    • 1
  • Yu-Chun Huang
    • 1
  • Takashi Kato
    • 1
  • Hwei-Ming Wang
    • 1
  • Abe Fingerhut
    • 1
  1. 1.Division of Colorectal Surgery, Department of SurgeryChina Medical University HospitalTaichung CityTaiwan

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