TAMIS repair of a rectal stenosis not treatable by endoscopy

Abstract

Since the description of transanal endoscopic microsurgery (TEM) by Buess [1] and the later appraisal of transanal endoscopic operation(TEO) and tranasnal minimally invasive surgery (TAMIS) [2], these approaches have been used for the treatment of rectal neoplasms such as benign or early stage rectal cancer [3,4].Moreover, the transanal approach continues to evolve, and new indications are emerging, such as the removal of foreign bodies and repair of rectourethral fistula [4].In this video, we present our experience with the TAMIS approach for the treatment of a rectal stenosis non-suitable for endoscopic dilatation.A 48-year-old woman had a history of rectal stenosis and pelvic sepsis after transanal resection of a large polyp with high-grade dysplasia located in the mid rectum. Due to this process, a diverting colostomy was fashioned, drainage of the perirectal abscess was performed and a loose seton was placed.After failure of conservative management, we decided to proceed with a TAMIS approach to the rectal stenosis. A proctoscopy and colonoscopy were done, and biopsies were also taken to rule out malignancy. The patient was prepared for surgery and informed consent was obtained.A GelPOINT Path (Applied Medical) for rectal access was used. The stenosis was located around 6 cm from the anal verge.A posterior rectotomy was carried out. Normal mucosa of the upper rectum was seen, and the presence of a rectal stenosis measuring 3-4 cm in length was confirmed.The rectotomy was enlarged until the perirectal fat was seen and then a Foley catheter (18 F).The patient was discharged uneventfully 1 day after the operation, and a proctoscopy with dilation was performed 1 month after surgery. The patient is now awaiting colostomy closure.The TAMIS approach may be used as an alternative for the treatment of rectal stenosis in selected cases, if conservative treatment and endoscopic dilatation are not feasible.

A combined abdominal and transanal minimally invasive (TAMIS) approach in redo anastomoses for severe refractory rectal strictures

“…The utility of transanal endoscopic microsurgery (TEM) has also been reported [6,7]. Finally, transanal minimally invasive surgery (TAMIS) using a single‐incision laparoscopic surgery platform has been shown to be a feasible option for management of refractory strictures [8–10].…”

TAMIS resection of a large colonic polyp 20 cm from the anal verge: could endo-stapling be the solution to peritoneal entry?

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Transanal minimally invasive surgery (TAMIS) has been used for the treatment of rectal neoplasms such as benign polyps and early rectal cancer [1,2]. After early experience, other applications have appeared and the use of TAMIS approaches has expanded [3,4]. Transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) resection for lesions above the rectosigmoid junction have been described [5], but TAMIS resection of these lesions is usually not considered feasible.We present the case of a 68-year-old male patient with large polyp located 20 cm from the anal verge, measuring 5 × 8 cm with a thick pedicle, which could not be resected with an endoscopic approach.

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