Radial incision and cutting method using a transanal approach for treatment of anastomotic strictures following rectal cancer surgery: a case report

Nepal, Pramod; Mori, Shinichiro; Kita, Yoshiaki; Tanabe, Kan; Baba, Kenji; Uchikado, Yasuto; Kurahara, Hiroshi; Arigami, Takaaki; Shimada, Masahiko; Maemura, Kosei

doi:10.1186/s12957-019-1592-x

Cited by 12 publications

(7 citation statements)

References 17 publications

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“…Endoscopic techniques for AS were effective, feasible, and safe but had a high re-stenosis rate of up to 20%[ 20 ]. Nepal et al [ 21 ] performed the RIC method for rectal stricture using a TAMIS approach. TAMIS may provide a wider operative field than endoscopy and allow a more complete resection because the surgeon can easily repair a defect in the muscular layer if a luminal perforation has occurred during surgery.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic radial incision and cutting technique for treatment-naive stricture of colorectal anastomosis: Two case reports

Lee

Yoon

Lee

2020

WJGS

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BACKGROUND Anastomotic stenosis (AS) after colorectal surgery was treated with balloon dilation, endoscopic procedure or surgery. The endoscopic procedures including dilation, electrocautery incision, or radial incision and cutting (RIC) were preferred because of lower complication rates than surgery and are less invasive. Endoscopic RIC has a greater success rate than dilation methods. Most reports showed that repeated RICs were needed to maintain patency of the anastomosis. We report that single session RIC was applied only to treatment-naive patients with AS. CASE SUMMARY Two female patients presented with AS. One patient had advanced rectal cancer and the other had a refractory stenosis following surgery for endometriosis at sigmoid colon. The endoscopic RIC procedure was performed as follows. A single small incision was carefully made to increase the view of the proximal colon and the incision was expanded until the surgical stapling line. Finally, we made a further circumferential excision with endoscopic knife along the inner border of the surgical staple line. At the end of the procedure, the standard colonoscope was able to pass freely through the widened opening. All patients showed improved AS after a single session of RIC without immediate or delayed procedure-related complications. Follow-up colonoscopy at 7 and 8 mo after endoscopic RIC revealed intact anastomotic sites in both patients. No treatment-related adverse events or recurrence of the stenosis was demonstrated during follow-up periods of 20 and 23 mo. CONCLUSION The endoscopic RIC may play a role as one of treatment options for treatment-naive AS with short stenotic lengths.

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Section: Discussionmentioning

confidence: 99%

Endoscopic radial incision and cutting technique for treatment-naive stricture of colorectal anastomosis: Two case reports

Lee

Yoon

Lee

2020

WJGS

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“…3 RIC is effective for treating refractory benign esophageal strictures, benign anastomotic stenoses, and CD-associated intestinal strictures. [18][19][20][21] At present, the indications of RIC are not clear.…”

Section: Retrieval Of Retained Capsule Endoscopy By Device-assisted Ementioning

confidence: 99%

Retrieval of retained capsule endoscopy by device‐assisted enteroscopy in patients with cryptogenic multifocal ulcerous stenosing enteritis

Jia

Xie

et al. 2020

J of Digest Diseases

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“…Most were then able to undergo balloon dilation [131]. Endoscopy, TEMS, [147], and TAMIS [148] have all been used to access the stricture and to perform the superficial incisions along the stricture or, in some cases, to fully resect the fibrotic tissue [149]. Using these techniques, success rates of 90-100% have been reported, albeit in small studies with variable long-term follow-up data.…”

Section: Anastomotic Stricturementioning

confidence: 99%

Anastomotic Complications

Friel

Kin

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Mechanical bowel prep and oral antibiotics prior to colon resection are associated with a lower risk of anastomotic leak.• A significant proportion of anastomotic leaks present after the immediate postoperative period, especially if there is a history of pelvic radiation. • Most early anastomotic bleeds are self-limited; late bleeds may be a sign of anastomotic leak. • Anastomotic stricture after cancer resection should undergo endoscopic biopsy and imaging to rule out recurrent cancer. • Benign anastomotic strictures may be amenable to endoscopic management, but some will require surgical revision or completion proctectomy with permanent colostomy if the strictured anastomosis is in the pelvis. • Anastomotic complications often lead to significant detriments to quality of life with regard to pain, defecatory function, sexual function, and urinary function. Discussion of these issues with patients is critical for surgical decision-making. Anastomotic LeakThe unfortunate reality faced by every surgeon who performs bowel resections is the occurrence of anastomotic leaks. The incidence of anastomotic leak after bowel anastomosis ranges from 2% to 21% and is associated with significant risk of short-and long-term morbidity [1][2][3][4][5]. This complication can be a devastating event that sets off a cascade of other unfortunate events, resulting in significant det-riments to quality of life, increased pain, prolonged disability, and sometimes death. Anastomotic leaks are associated with significantly higher healthcare resource utilization and cost, as patients with this complication are more likely to require additional diagnostic tests, procedures or reoperations, hospital days, outpatient care, and readmissions [6,7]. Perhaps the most frustrating aspect of anastomotic leaks in colorectal surgery is the fact that leaks and their severe consequences still occur despite the adoption of evidence-based perioperative guidelines, efforts to optimize patient risk factors, and adherence to surgical principles. Although important progress has been made toward reducing the risk of anastomotic leak, there is still much work to be done to increase our understanding of the pathophysiology of anastomotic leak, and effective strategies for prevention.

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Radial incision and cutting method using a transanal approach for treatment of anastomotic strictures following rectal cancer surgery: a case report

Cited by 12 publications

References 17 publications

Endoscopic radial incision and cutting technique for treatment-naive stricture of colorectal anastomosis: Two case reports

Endoscopic radial incision and cutting technique for treatment-naive stricture of colorectal anastomosis: Two case reports

Retrieval of retained capsule endoscopy by device‐assisted enteroscopy in patients with cryptogenic multifocal ulcerous stenosing enteritis

Anastomotic Complications

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