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Preventing anastomotic leakage after laparoscopic intersphincteric resection without a diverting stoma: "pull‐through/reborn"
Author(s) -
Hamamoto Hiroki,
Okuda Junji,
Yamamoto Masashi,
Masubuchi Shinsuke,
Ishii Masatsugu,
Osumi Wataru,
Tanaka Keitaro,
Uchiyama Kazuhisa
Publication year - 2021
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12841
Subject(s) - medicine , surgery , coloanal anastomosis , anastomosis , mesorectum , stoma (medicine) , rectum , indocyanine green , colorectal cancer , total mesorectal excision , cancer
Patients with very low rectal cancer who undergo intersphincteric resection (ISR) often experience anastomotic leakage (AL), even with a diverting stoma. The aim of this study was to introduce a technique for anastomosis after laparoscopic ISR to avoid AL. Materials and Surgical Technique In the first ISR procedure, the rectum was mobilized, the mesorectum was excised, and total, subtotal, or partial internal sphincter incision was performed transanally. In the second surgery, the adhesions between the prolapsed colon and the anal canal were bluntly dissected only as needed for suturing. After sufficient blood flow was confirmed using indocyanine green fluorescence imaging, coloanal transanal anastomosis was performed without a diverting stoma. We call this method “pull‐through/reborn”. Discussion “Pull‐through/reborn” method can prevent AL after laparoscopic ISR. However, more cases and more experience are necessary to analyze anal functions after this method is applied.