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Pure transanal laparoscopic repair of early rectovaginal fistula
Background: Rectovaginal fistula is an abnormal connection between the rectum and the vagina, with leakage of rectal contents through the vagina. Different surgeries have been attempted such as direct repair, plug placement, advancement flap, muscle interposition, colostomy, proctectomy or delayed pull-through colo-anal anastomosis. Recently, transanal minimally invasive surgery has been described amongst the surgical options.

Video: The authors present a pure transanal laparoscopic repair of early rectovaginal fistula in a 74-year-old lady, submitted 3 weeks before to a laparoscopic anterior resection of the rectum with ‘en bloc’ hysterectomy for rectal adenocarcinoma (pT4aN0M0). A protective ileostomy was performed at the time of rectal surgery, and the postoperative course was uneventful. After having positioned the patient in a gynecologic position, a new reusable transanal platform according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) was adopted. The exploration of the lower rectum put in evidence a 2cm rectovaginal fistula, located at a 3 o’clock position and at a 12cm distance from the anal margin. Absorbable figure-of-8 sutures using Vicryl 2/0 were performed to close the defect. Thanks to the curves of the instruments, the surgeon worked under ergonomic positions, without clashing of the instruments’ tips and any conflict of the surgeon’s hands. At the end of the procedure, injection of methylene blue through the vagina did not show any passage of the product into the lower rectum.

Results: The operative time was 120 minutes and intraoperative bleeding was insignificant. The postoperative course was uneventful, and patient discharge was allowed after 6 days. Due to the reusable nature of all the material implemented, no supplementary cost was necessary. The gastrograffin enema after 2 months showed a complete healing of the fistula. As a result, the protective ileostomy was closed.
Conclusion: Rectovaginal fistula can be repaired through a pure transanal laparoscopy, which prevents complicated and demolition surgeries usually performed through the abdomen.
G Dapri, M Degueldre
Surgical intervention
3 years ago
1475 views
96 likes
0 comments
04:58
Pure transanal laparoscopic repair of early rectovaginal fistula
Background: Rectovaginal fistula is an abnormal connection between the rectum and the vagina, with leakage of rectal contents through the vagina. Different surgeries have been attempted such as direct repair, plug placement, advancement flap, muscle interposition, colostomy, proctectomy or delayed pull-through colo-anal anastomosis. Recently, transanal minimally invasive surgery has been described amongst the surgical options.

Video: The authors present a pure transanal laparoscopic repair of early rectovaginal fistula in a 74-year-old lady, submitted 3 weeks before to a laparoscopic anterior resection of the rectum with ‘en bloc’ hysterectomy for rectal adenocarcinoma (pT4aN0M0). A protective ileostomy was performed at the time of rectal surgery, and the postoperative course was uneventful. After having positioned the patient in a gynecologic position, a new reusable transanal platform according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) was adopted. The exploration of the lower rectum put in evidence a 2cm rectovaginal fistula, located at a 3 o’clock position and at a 12cm distance from the anal margin. Absorbable figure-of-8 sutures using Vicryl 2/0 were performed to close the defect. Thanks to the curves of the instruments, the surgeon worked under ergonomic positions, without clashing of the instruments’ tips and any conflict of the surgeon’s hands. At the end of the procedure, injection of methylene blue through the vagina did not show any passage of the product into the lower rectum.

Results: The operative time was 120 minutes and intraoperative bleeding was insignificant. The postoperative course was uneventful, and patient discharge was allowed after 6 days. Due to the reusable nature of all the material implemented, no supplementary cost was necessary. The gastrograffin enema after 2 months showed a complete healing of the fistula. As a result, the protective ileostomy was closed.
Conclusion: Rectovaginal fistula can be repaired through a pure transanal laparoscopy, which prevents complicated and demolition surgeries usually performed through the abdomen.
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
Gf Donatelli, S Perretta, M Ignat, M Pizzicannella, D Mutter, J Marescaux
Surgical intervention
1 year ago
992 views
6 likes
0 comments
14:45
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
Chronic sigmoidovesical fistula: laparoscopic management
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.
J Leroy, A D'Urso, H Jeddou, D Mutter, J Marescaux
Surgical intervention
5 years ago
2120 views
62 likes
0 comments
07:01
Chronic sigmoidovesical fistula: laparoscopic management
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.
Laparoscopic repair of colorectal leak and fistula using a new transanal reusable platform
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.
G Dapri, D Guta, K Grozdev, L Antolino, K Jottard, GB Cadière
Surgical intervention
4 years ago
1707 views
34 likes
0 comments
05:55
Laparoscopic repair of colorectal leak and fistula using a new transanal reusable platform
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.
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
HA Mercoli, L Marx, J Leroy, P Pessaux, J Marescaux
Surgical intervention
5 years ago
6124 views
177 likes
0 comments
07:11
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
A Llueca, JL Herraiz, M Rodrigo, Y Maazouzi, D Piquer, M Guijarro, A Cañete, J Escrig
Surgical intervention
4 years ago
3297 views
126 likes
0 comments
07:16
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.