Aim
Total proctocolectomy with ileal pouch−anal anastomosis (IPAA) is the standard surgical treatment modality for familial adenomatous polyposis (FAP). It is challenging to perform proctectomy and preserve anal sphincter function. In this video, precise mucosectomy of the anal canal via transanal minimally invasive surgery (MAC‐TAMIS) is reported.
Methods
An asymptomatic 35‐year‐old man was found to have a positive faecal occult blood test in routine screening examination and was diagnosed with FAP on colonoscopic examination. The patient was scheduled for total proctocolectomy with IPAA using the TAMIS approach combined with transanal total mesorectal excision. MAC‐TAMIS was performed to preserve the internal anal sphincter during laparoscopy.
Results
The total duration of surgery was 543 min, blood loss was minimal, and the postoperative course was uneventful. The postoperative hospital stay was 12 days. The pathological findings demonstrated no evidence of malignancy. Gastrographic imaging from the ileostomy showed sufficient size of the J pouch and good tonus of the anus at 6 months after surgery. The Wexner scores at 1, 3 and 6 months after ileostomy closure were 5, 3 and 0, respectively.
Conclusion
The MAC‐TAMIS technique is safe and feasible during total proctocolectomy with IPAA in patients with FAP. This technique allows us to precisely preserve the internal anal sphincter using a laparoscopic approach.
Purpose: Transanal total mesorectal excision (TaTME) for low anterior resection requires a secure anastomotic technique to avoid an anastomotic leak. This study aimed to evaluate the clinical outcomes of a novel technique of quadruple purse-string suture (PSS) for single stapling technique (SST) following TaTME.
Methods: Consecutive patients who underwent TaTME with SST for rectal cancer between November 2014 and October 2020 were enrolled. Clinical outcomes of quadruple or double PSS for SST following TaTME were evaluated. The complete rates of the resection rings based on the status of the resection ring of the colonic and rectal stumps were also evaluated.
Results: In total, 47 patients were included in the study: 27 and 20 in the quadruple and double PSS groups, respectively. Intraoperative adverse events occurred in one patient. The rates of postoperative complications in the quadruple and double PSS groups were 22.2% and 30.0%, respectively. The rates of anastomotic leaks in the quadruple and double PSS groups were 7.4% and 15.0%, respectively. The length of hospital stay in the quadruple and double PSS groups was 13 and 14 days, respectively. The resection ring for the rectal stump was complete in 85.2% of quadruple PSS cases and 70.0% of double PSS cases. The resection rings for both stumps were complete in 81.5% and 50.0% of patients with quadruple and double PSS, respectively (p=0.03).
Conclusion: Quadruple PSS for SST following TaTME is feasible and seems to be a safe alternative to conventional double PSS in selected patients with rectal cancer.
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