Laparoscopic revision of stenotic colorectal anastomosis
Epublication WebSurg.com, Apr 2013;13(04). URL: http://websurg.com/doi/vd01en3896
Background: Colorectal anastomosis is usually performed using a circular stapler inserted transanally. Postoperative complications such as strictures are rare and related to various factors like ischemia, poor vascularization, and previous leak. This video shows a laparoscopic revision of a stenotic colorectal anastomosis, solved with a new hand-sewn anastomosis. Video: A 51-year-old man underwent laparoscopic sigmoidectomy for symptomatic diverticulosis. At that time, a transanal circular mechanical end-to-end colorectal anastomosis was performed using a 29mm circular stapler. After 3 months of follow-up, a symptomatic stenotic colorectal anastomosis was evidenced, and endoscopic dilatation (repeated 3 times) remained unsuccessful. Preoperative barium enema showed a stenotic anastomosis and some residual diverticulosis. A laparoscopic 3-trocar revision was scheduled. On exploration of the abdominal cavity, the anastomosis appeared thickened and strictly adherent to the left ureter. After proper mobilization, a segmental colorectal resection was performed and a new anastomosis was fashioned in an end-to-end hand-sewn technique. Results: The procedure was completed by laparoscopy without additional trocars. Operative time was 202 minutes and blood loss 20cc. The patient was allowed to be discharged on the 4th postoperative day, and after 6 months, he is fine, without intestinal trouble. Conclusions: Postoperative complications of colorectal anastomosis, such as strictures, can be managed laparoscopically. A new hand-sewn anastomosis is feasible and it allows for control of the vascularization and openings of both colonic and rectal lumens.