Laparoscopic repair of colorectal leak and fistula using a new transanal reusable platform
Epublication WebSurg.com, Sep 2015;15(09). URL: http://websurg.com/doi/vd01en4546
Background: Transanal minimally invasive surgery has triggered much interest and investment in research over the last decade. This approach can be used not only to perform primary procedures (e.g., polypectomy, TME), but also to manage intraoperative complications such as leaks, bleedings, and late complications such as fistulas. Video: The first part of the video shows the repair of an immediate colorectal leak using transanal laparoscopy, in a 50-year-old woman who underwent a laparoscopic anterior resection of the rectum. During anastomotic control, a posterior leak 4cm away from the anal margin was found. A new transanal reusable port, named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany), along with DAPRI monocurved reusable instruments, was implemented. The second part of the video shows a persisting and symptomatic colorectal fistula, located posteriorly 11cm away from the anal margin, in a 65-year-old man who had undergone a laparoscopic anterior resection of the rectum 4 weeks earlier. Results: Operative time was 60 and 45 minutes respectively. Patients were discharged after 5 and 2 days respectively. Controls at 2 months (before ileostomy closure) showed a complete healing of the defects. Conclusions: Complications after anterior resection of the rectum, such as intraoperative leak and late colorectal fistula, can be treated using transanal laparoscopy. This new transanal platform offers surgeons the possibility to work in ergonomic positions without increasing the cost of the procedure thanks to the reusable nature of the material adopted.