Abstract
AimThe aim of this study was to report on the feasibility of transanal minimally invasive surgery (TAMIS) as a novel approach to redo colorectal or ileoanal anastomoses.MethodsFrom October 2014, a prospective institutional database was created for all consecutive patients who underwent redo surgery by TAMIS for presacral sinus or anastomotic stenosis after low anterior resection or pouch-related problems following restorative proctocolectomy. Intra-operative feasibility, 30-day postoperative outcomes, intestinal continuity and complications after 6-month follow-up were evaluated.ResultsOf 17 included patients, 14 underwent anastomotic reconstruction and three completion proctectomy. The median operation time was 265 min (range 201–413). A successful rendezvous with simultaneous transabdominal access was achieved in 15 patients, and the procedure was completed by TAMIS alone in two. Five patients were readmitted within 30 days (29 %). Two (14 %) patients developed an anastomotic leakage within 30 days and 4 (24 %) developed a pelvic abscess requiring reintervention. One patient developed an urethra stenosis and was managed with a suprapubic catheter. Median follow-up was 9 (6–15) months. Within 6-month follow-up, the redo-TAMIS 1 patient developed a delayed anastomotic leak and 1 patient had a recurrent presacral abscess after stoma closure. Intestinal continuity was reached in 71 % of the patients at 6-month follow-up.ConclusionTAMIS is a valuable approach in redo pelvic surgery, but is still associated with high complication rates related to the complexity of the underlying problem.
Highlights
The present study indicates that the transanal minimally invasive surgery (TAMIS) technique is feasible and useful for redo pelvic surgery following low anterior resection (LAR) or ileo-pouch anal anastomosis (IPAA)
Performing the otherwise troublesome low pelvic dissection via the bottom-up approach facilitates the exposure of an area that is difficult to access transabdominally due to altered anatomy, chronic inflammation related to anastomotic insufficiency, prior surgery with scar tissue and preoperative radiotherapy (Fig. 4)
The future sustainability of the TAMIS technique will be determined by the quality of the surgery which can be assessed by total mesorectal excision (TME) specimen grading, the circumferential margin and the long-term oncologic outcomes
Summary
The aim of this study was to report on the feasibility of transanal minimally invasive surgery (TAMIS) as a novel approach to redo colorectal or ileoanal anastomoses. The aim of this study was to report on the feasibility of the TAMIS approach for redo pelvic surgery based on the possibility to achieve a rendezvous with simultaneous transabdominal access at a predefined level
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
