Modified teniectomy. A new technique for creation of sutureless colonic reservoir

Abstract

Construction of colonic reservoir has been shown to decrease the incidence, duration, and severity of bowel dysfunction following low anterior resection. Different techniques to construct such reservoir had been described, including colonic J-pouch and coloplasty techniques. Unfortunately, both procedures have their own disadvantages. Teniectomy of the antimesenteric taeniae coli as an alternative technique had been used in two cases to construct a sutureless colonic reservoir, which has its own advantages and avoids inherent drawbacks of the presently available techniques. In the present technical report, a modification of the teniectomy technique had been done by the inclusion of the circular muscle layer with the teniectomy (i.e., short of the submucosa) to effect widening of the teniectomized colonic segment for the creation of a sutureless colonic reservoir after low anterior resection. The technique was used in two patients suffering from carcinoma of the lower one-third of the rectum. The first patient was a 35-year-old female with a history of tenismus and bleeding per rectum of 6 months duration, and the second patient was a 58-year-old female with bleeding and mucous per rectum of 2 months duration. Both of them were proven to have grade 2 adenocarcinoma of the rectum 4 and 5 cm from the anal verge, respectively, with no evidence of distant metastases. Both patients underwent a sandwich technique of combined preand postoperative radio-chemotherapy, given as recommended by other authors. The technique involved total mesorectal excision technique, which was described by Heald et al. In both cases, the upper 2 cm of the anal canal was excised to achieve an adequate 2-cm distal safety margin and was combined with transanal mucosectomy down to the dentate line. Both patients had short mesentery, which rendered the creation of colonic J-pouch difficult, and at the time of the operation on the first patient, the report on the coloplasty technique was not published yet (in February 2000). The second patient was operated on 2 years later. The technique of teniectomy was performed by choosing one of the antimesentric teniae coli about 5 cm proximal to the divided bowel end. The submucosal plane of the chosen teniae coli was infiltrated with 20 cm of 1:100,000 adrenaline in saline solution for a distance of 20 cm. A transverse incision was done in each tenia coli 5 cm proximal to the divided bowel end, which is deepened to the submucosal plane where two vertical incisions were made from both ends of the first one and extended proximally for 20 cm up in the colon, which was followed by excision of the tenia coli with its underlying circular muscle fibers down to the submucosa using combined blunt and sharp dissection. The teniectomy was completed by transversely connecting the two vertical incisions to remove the extended teniectomy specimen. The integrity of the mucosa was confirmed before the coloanal anastomosis by visually inspecting the mucosa from outside during gentle finger palpation from inside of the teniectomized segment and by injecting 100 cm of methlylene blue colored saline into the pouch after the Int J Colorectal Dis (2008) 32:209–210 DOI 10.1007/s00384-007-0314-y