BackgroungAnorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment.AimTo describe the technique and initial experience with the technique video-assisted for anal fistula treatment.TechniqueA Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture.ResultsThe mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient.ConclusionVideo-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

Introduction Anal fistula is an epithelised path between the rectum or anal canal and the perianal region. The use of laparoscopic surgery with a minimally invasive procedure has led to the development of video-assisted surgical treatment of anal fistula. Objective To describe the surgical technique VAAFT as a new approach to fistula. Conclusion This is a safe and reproducible procedure. It enables the study of the entire fistula, obtaining the identification of accessory paths, cavitations and of the inner hole. More studies should be published for a better analysis of this technique, as well as to have a long-term outcome with new publications.

Introduction The pilonidal cyst is a chronic inflammatory process that occurs frequently in the sacrococcygeal region. It is more common in males with a ratio of 3:1 and usually presents itself in the third decade of life. The treatment is mainly surgical with various forms. The search for new technologies as well as for a minimally invasive treatment has become of utmost importance in surgical routines. The technique E.P.Si.T. (endoscopic treatment of pilonidal cyst) developed by Meneiro has been quite interesting in the treatment of pilonidal cysts. Surgical technique Anesthetized the patient in the supine position. Identified the drainage hole of the cyst, and began with the passage of fistuloscope studying the path of the cyst. Performs following the removal of all the tissue inside as the hair followed by cauterization of the path. Removed all devitalized tissue and enlargement of the opening of the cyst.

Transanal endoscopic microsurgery is a minimally-invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margins and lower recurrence rates, when compared to conventional transanal excision. The aim of this study was to describe a single institution's initial experience with transanal minimally invasive surgery (TAMIS). This was a prospective review of our database. Eleven procedures from January 2012 to June 2013 were analyzed. Results eleven operations were completed. Five men were evaluated. Mean age was 62.9 (40-86). Mean follow-up was 9.3 (2-17) months. Average tumor size was 3.8 (1.8-8) cm. Mean distance from anal verge was 6.3 (3-12) cm. Mean operating time was 53.73 (28-118) min. Postoperative complication rate was 9.1%. There were no readmissions. Mortality was null. Operative pathology disclosed the presence of adenoma in four patients, invasive adenocarcinoma in two, neuroendocrine carcinoma in three, and no residual lesion in one case. TAMIS is a minimallyinvasive procedure with low postoperative morbidity at the initial experience. TAMIS is a curative procedure for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers, pending the results of multi-institutional trials.

Transanal endoscopic microsurgery is a technique created in the 1980's for resections of rectal tumors. This technique is a good option for the resections of rectal tumors, with low morbidity and mortality. Objective: To report the initial experience of two different services in the Brazilian Northeast, Bahia and Pernambuco. Methods: Retrospective and descriptive data collected from January 2010 to June 2012 regarding the postoperative outcomes of patients who underwent transanal endoscopic microsurgery for rectal tumor resection in these services. Results: Our initial experience consisted of 52 patients, being 59.6% males; 71.2% were benign diseases, and the mean distance from the anal margin was 5.6 cm. Mean hospital stay was 1.2 days. Complications included bleeding, perforation and entry to the abdominal cavity in three cases, as well as suture dehiscence and neoplasm recurrence in an advanced adenocarcinoma. Conclusion: Transanal endoscopic microsurgery is an excellent technical option for the resection of rectum adenomas, which are not feasible for endoscopic resection. The procedure may be used for other indications, as the resection of anal fistulae, being an useful instrument in colorectal surgery.

Introduction Colorectal cancer is a serious public health problem. In 1982, Heald managed to reduce mortality by standardizing the total excision of mesorectum. The use of transanal endoscopic microsurgery has emerged to allow resection of rectal tumors as a minimally invasive method. With the association of Transanal Endoscopic Operation with total excision of mesorectum, it was possible to develop a new approach for total excision of mesorectum. Surgical technique The procedure is started by the perineal time with Transanal Endoscopic Operation device; introduction of Transanal Endoscopic Operation system follows, with exposure of the lesion with a circumferential incision at a distance between 2 and 4 cm from distal tumor margin after making a purse string suture to close the rectal stump. Then, dissection is carried out by the posterior portion until reaching the presacral avascular fascia, completing the mesorectal circumferential dissection until the peritoneal reflection. After this step, a laparoscopic procedure is performed with the use of three trocars, with mobilization of splenic flexure and ligation of the inferior mesenteric artery, as well as confection of a protective ileostomy. Then, transanal removal of the surgical specimen is performed, and the procedure goes on with a coloanal anastomosis.

Introduction laparoscopic colorectal surgery has become a viable access route since the beginning of 1990, using Jacobs’ technique. Its outcomes are decrease in hospitalization length, early return to routine activities, better esthetic results and less postoperative pain. Objective to report a series of patients treated by a team using videolaparoscopic access route in colorectal surgery. Material and methods retrospective, descriptive study carried out in Salvador, state of Bahia, Brazil, from April of 2010 to May 2012. Results a total of 81 procedures were analyzed; 59.3% of cases were females, mean age was 58.3 years. Benign illness was treated in 48.1% to the patients. Rectosigmoidectomy was carried out in 41.5% and right colectomy in 21%. Intraoperative complications were observed in 3.7% and postoperative in 21% of cases, with a conversion rate of 6.2%. Conclusion the laparoscopic procedure showed to be safe and the surgeon's training results in better outcomes in this series.

The low number of registration of colorectal cancer cases in Brazil has shown the difficulty in understanding the epidemiology of this disease, thus leading to a poor government planning for early diagnosis. The aim of this study was to report the cases of a service in Salvador during three years and compare it with the national literature data. The data were analyzed, and we found similarity to the Brazilian literature: higher incidence among females (53.7%), mean age of 57 years at diagnosis. Stage III was observed in 40.4% of patients, and retossigmoidectomy surgery was most often performed (54%). This study showed epidemiological characteristics of the population of Bahia, being observed late diagnosis of the disease and the need for investment in early detection.