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Transanal and transabdominal combined endoscopic resection of rectal stenosis and anal reconstruction based on transanal endoscopic technique

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Abstract

Objective

To propose a method for the resection of the rectal anastomotic stenosis and anal reconstruction based on the transanal endoscopic technique through a transanal and transabdominal combined endoscopic resection, and to verify its clinical effectiveness.

Methods

Thirty-eight patients with anastomotic stenosis were admitted to the Sixth Affiliated Hospital, Sun Yat-sen University, China, from January 2016 to September 2019. Patients were divided into an experimental group (17 patients) and a control group (21 patients) subjected to the removal of the intestinal stenosis followed by anal reconstruction, they underwent transanal and transabdominal endoscopic surgery and traditional transabdominal surgery, respectively. Data on intraoperative blood loss, operation time, postoperative recovery, and prognosis were collected.

Results

(1) The median intraoperative blood loss was approximately 100 ml, without conversion to laparotomy during the surgery and intraoperative complications. The safety of the surgical operation was improved. (2) The operation time was shortened compared to previous reports, and the median operative time was 193 min. The average time of transanal endoscopic dissociation to the retroperitoneal fold was 76 min. (3) Laparoscopic assistance was carried out on 14 of the17 patients, and the incision was reduced. (4) The short-term curative effect was quite satisfactory, without permanent stoma. The average time to recover food intake after the surgery was 1.5 days. The average ambulation time was 3 days. Within 30 days after the surgery, one case suffered anastomotic leakage and then underwent refunctioning stoma through a second surgery. One patient suffered from intestinal obstruction, and the condition was improved through a conservative treatment. One case experienced delayed abdominal wound healing.

Conclusion

The transanal and transabdominal endoscopic resection of the rectal anastomotic stenosis and anal reconstruction reduced the difficulty of the surgery, improved its safety, shortened the operation time, decreased the operative complications, and enabled patients to recover well after surgery.

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Acknowledgements

This study was supported by National Health and Medical Research Council (NHMRC) Grant (1158402), Natural Science Foundation of Guangdong Province (China) (2018A030313621), and Sun Yat-sen University Clinical Research 5010 Program (China) (2016005).

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Author notes

  1. Shuangling Luo and Xingwei Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China

    Shuangling Luo, Xingwei Zhang, Yujie Hou, Huanxin Hu & Liang Kang

  2. Guangdong Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, Guangdong, China

    Shuangling Luo, Xingwei Zhang, Yujie Hou, Huanxin Hu & Liang Kang

  3. UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australa, Adelaide, SA, 5001, Australia

    Jianghui Dong & Liping Wang

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  1. Shuangling Luo
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Correspondence to Liping Wang or Liang Kang.

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All authors including Drs. Shuangling Luo, Xingwei Zhang, Yujie Hou, Huanxin Hu, Jianghui Dong, Liping Wang and Liang Kang have no conflicts of interest or financial ties to disclose.

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Luo, S., Zhang, X., Hou, Y. et al. Transanal and transabdominal combined endoscopic resection of rectal stenosis and anal reconstruction based on transanal endoscopic technique. Surg Endosc 35, 6827–6835 (2021). https://doi.org/10.1007/s00464-020-08188-x

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  • DOI: https://doi.org/10.1007/s00464-020-08188-x

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