Annals of Coloproctology

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Malignant disease

Transanal Endoscopic Microsurgery: Endoscopy Assisted Treatment of Colorectal Anastomotic Stenosis: Giancarlo D'Ambrosio, Antonietta Lamazza, Rossella Palma, Andrea Picchetto, Cristina Panetta, Antonello Trecca, Stefano Pontone, Emanuele Lezoche; Ann Coloproctol. 2020;36(4):285-288. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.30.3

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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.

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Eight Years Experience of Transanal Endoscopic Microsurgery
Seyed Vahid Hosseini, Mohammad Rezazadehkermani, Ali Abdulridha Abbas Algharah, Alimohammad Bananzadeh, Seyedeh Saeideh Shahidinia, Mehrdad Haghazali
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Transanal Minimally Invasive Surgery for Rectal Anastomotic Stenosis After Colorectal Cancer Surgery
Wei Zhou, Lian Xia, Zian Wang, Gaoyang Cao, Li Chen, Engeng Chen, Wei Zhang, Zhangfa Song
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Application of endoscopic technique in completely occluded anastomosis with anastomotic separation after radical resection of colon cancer: a case report and literature review
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Surgically Correctable Fecal Incontinence Associated with Traumatic Duhamel Operation: A Report of Three Cases.: Yoon, Wan Hee , Choi, Jeong Hun; J Korean Soc Coloproctol. 2002;18(2):137-140.

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Abstract PDF: We present 3 cases of fecal incontinence associated with traumatic injury during Duhamel procedure. Three male patients suffered from persistent fecal soiling and incontinence for more than 7 years after definitive surgery for Hirschsprung's disease by a pediatric surgeon. They showed grade 4 frequent major soiling, mild patulous anus, and flattening of the anorectal angle due to traumatic injury of the external sphincter and puborectalis muscle on the posterior midline of the anorectal junction. On Parks postanal pelvic floor repair procedures, the incontinent symptoms were abated, anatomic changes were normalized, and postoperative Kirwan classification scales were markedly improved from grade 4 to grade 1. Patients with fecal incontinence after Duhamel operation for Hirschsprung's disease may have a traumatic injury of the anal sphincter. Careful physical and laboratory examinations should be performed for the confirmation of traumatic injury in these patients, and Parks postanal repair could be the treatment of choice for the correction of incontinence.

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