Abstract
Purpose
Resection of a long rectal stump after previous colectomy or Hartmann procedure often requires a combined transperitoneal and transperineal approach because of limited access through a perineal incision alone. Risks associated with this procedure include iatrogenic injury to bowels, nerves, ureters, vessels and sexual organs. This study reports on the feasibility and safety of perianal minimally invasive surgery (PAMIS) for the resection of long rectal stumps that would otherwise require a combined transperitoneal and perianal approach.
Methods
PAMIS utilizes standard laparoscopic equipment and a single access port to dissect the rectal stump following the mesorectal fascia into the pelvis after excision of the anal canal. Three PAMIS procedures were performed between February and April 2016. Feasibility, safety and outcome were analysed.
Results
Three patients with previous colectomy and ostomy creation due to colitis ulcerosa (n = 2) and idiopathic enteropathy (n = 1) underwent PAMIS. The rectal stump length ranged between 10 and 19 cm. The median postoperative length of stay was 9 (range 6 to 11) days and the median operating time was 90 (range 80 to 120) min. There were no perioperative complications.
Conclusion
PAMIS is a feasible, safe and efficient procedure for rectal stump resection avoiding the transperitoneal approach for pelvic dissection.
References
Poppen B, Svendberg T, Bark T (1996) Perineal excision of the rectum. Br J Surg 83:366–367
Bemers AJ, van Laarhoven KJ, van der Kolk BM, de Wilt JH, van Goor H (2013) Transanal endoscopic microsurtery approach for rectal stump resection as an alternative to transperitoneal stump resection. Br J Surg 100:568–671
Ogilvie JW, Ricciardi R (2009) Complications of perineal surgery. Clin Colon Rectal Surg 22:51–59
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The authors declare that they have no conflict of interest.
Informed consent
Informed consent was obtained by all patients before surgery. All patients have signed a statement on consent for publication of their data.
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Lorenz, A., Kogler, P., Huth, M. et al. Perianal minimally invasive surgery (PAMIS) for rectal stump resection after previous colectomy. Int J Colorectal Dis 33, 823–826 (2018). https://doi.org/10.1007/s00384-018-3013-y
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DOI: https://doi.org/10.1007/s00384-018-3013-y