Transanal endoscopic operation (TEO) repair of rectovaginal fistula and anastomotic leakage: a case series

Abstract

Introduction. Interest in transanal endoscopic surgery has increased in the last decade. This approach allows primary procedures such as polypectomy, local tumor excision, as well as the treatment of postoperative complications including bleeding, leakage and fistula formation. The aim of this study was to describe our group’s use of Transanal endoscopic operation (TEO) in the repair of fistulae and anastomotic leakage, performed by one experienced surgeon (F.C.). Case presentation. Here, we describe three patients who developed postoperative complications after been subjected to anterior rectal resection. One of them developed a leakage of the anastomosis in third postoperative day, the others developed recurrent fistulae a long time after the surgery. These complications were all treated using TEO (transanal endoscopic operation) platform. The transanal procedure in one case was performed three times, because of the recurrence of the fistula. In another case it was associated with laparoscopy to treat peritonitis occurred after anastomotic disruption. In the last case, the patient had history of years of fistula recurrence associated with pelvic abscess, TEO approach proved to be determinant in the resolution of the problem. In all cases the transanal surgery definitively repaired the defect, the patients were discharged and, up to date, they are without recurrence. Conclusions. Thus, in the hands of experienced surgeons and in selected cases, TEO system appears to be a valid option to treat post-operative complications, such as fistulae and anastomotic leakage, avoiding major surgery with greater associated morbidity and showing excellent results.