Use of gracilis flap interposition in repair of urethrorectal fistulae, whether through a transperineal or transanal approach

Rectovaginal fistula (RVF) is a type of anastomotic leakage that may occur after low anterior resection for rectal cancer. The repair of RVF can be challenging because of the scar tissue stenosis and incomplete obstruction. Two patients presented in our department with vaginal faecal discharge almost 7 months after the radical resection of rectal cancer. On vaginal examination, titanium nails related to the rectal surgery were found in the vaginal wall. The patients were diagnosed with RVF. Considering that RVF positions in the patients were high and might adhere to the pelvic tissue, a combined transabdominal–transanal resection and vaginal repair surgery was performed. About 3 months after surgery, both patients underwent colonic closure surgery, with consequent good recovery. A combined transabdominal–transanal approach may provide distinct advantages in surgical repair of difficult cases of RVF.

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Transanal approach for hirschsprung disease which present late, revive of last two years data at Alhada Armed Forces hospital

Clinical Pediatrics Open Access ◽

10.4172/2572-0775-c4-018 ◽

2018 ◽

Vol 03 ◽

Author(s):

Ubaid Ullah Khan et al

Keyword(s):

Hirschsprung Disease ◽

Armed Forces ◽

Transanal Approach

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Perineal Transanal Approach for Laparoscopic Sphincter-saving Resection in Low Rectal Cancer

Annals of Surgery ◽

10.1097/sla.0000000000000985 ◽

2017 ◽

Vol 265 (4) ◽

pp. e32-e33

Author(s):

Haiyang Zhou ◽

Canping Ruan ◽

Zhiqian Hu

Keyword(s):

Rectal Cancer ◽

Low Rectal Cancer ◽

Transanal Approach ◽

Sphincter Saving Resection ◽

Sphincter Saving

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Rectal Atresia—Operative Management with Endoscopy and Transanal Approach: A Case Report

Minimally Invasive Surgery ◽

10.1155/2011/792402 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Pernilla Stenström ◽

Christina Clementson Kockum ◽

Einar Arnbjörnsson

Keyword(s):

Case Report ◽

Physical Examination ◽

Surgical Techniques ◽

Operative Management ◽

Rectal Anastomosis ◽

Transanal Approach ◽

X Ray ◽

Rectal Atresia ◽

Newborn Child

The aim of this study is to present the technique and outcome of the management of a newborn child with rectal atresia. A girl born with rectal atresia was diagnosed during physical examination and confirmed with X-ray. The anatomic appearance of the external anus, and lower pelvis was normal. The rectal ending was located 2 cm cranial from the anus and the distance between the rectal endings was 2 cm. A colostomy was established. At the age of five months the child was operated on with a rectal anastomosis using the endoscopic and transanal approach. Closure of the colostomy was performed at the age of ten months. The rectal anastomosis was treated with rectal dilatation weekly in order to avoid stricture. The patient was faecally continent at followup one and three months postoperatively. In conclusion, the endoscopic and transanal approach is an alternative to other surgical techniques in the management of rectal atresia.

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Natural Orifice Specimen Extraction in Laparoscopic Colorectal Surgery: Transanal Approach

Techniques in Minimally Invasive Rectal Surgery ◽

10.1007/978-3-319-16381-9_10 ◽

2017 ◽

pp. 143-149

Author(s):

Morris E. Franklin ◽

Miguel A. Hernández

Keyword(s):

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Transanal Approach

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Transanal-only Swenson-like pull-through for late diagnosed Hirschsprung disease

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz341 ◽

2019 ◽

Vol 2019 (12) ◽

Cited By ~ 1

Author(s):

Rebecca M Rentea ◽

Devin R Halleran ◽

Hira Ahmad ◽

Elias Maloof ◽

Richard J Wood ◽

...

Keyword(s):

Transition Zone ◽

Prone Position ◽

Surgical Approach ◽

Patient Population ◽

Neonatal Period ◽

Hirschsprung Disease ◽

Small Subset ◽

Newborn Period ◽

Transanal Approach ◽

Pull Through

Abstract Hirschsprung disease (HD) is an obstructive colonic process usually diagnosed in the neonatal period. A small subset of cases are diagnosed late, present with severe constipation without enterocolitis and have low rectosigmoid disease. A transanal-only pull-through is a well-described approach but in the newborn period risks a situation whereby the transition zone is higher than the sigmoid. We present our experience with the unique patient population of older HD patients in whom the transition zone was reliably reachable via a single-stage transanal approach, performed in prone position. Patients between 2 and 6 years of age with a rectal or sigmoid transition zone and minimal proximal colonic dilation can undergo a primary transanal pull-through surgical approach.

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Evolution of Transanal Total Mesorectal Excision

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0039-3402773 ◽

2020 ◽

Vol 33 (03) ◽

pp. 113-127

Author(s):

Heather Carmichael ◽

Patricia Sylla

Keyword(s):

Minimally Invasive ◽

Total Mesorectal Excision ◽

Surgical Techniques ◽

Colorectal Disease ◽

Surgical Approaches ◽

Transanal Total Mesorectal Excision ◽

Rectal Disease ◽

Mesorectal Excision ◽

Invasive Approach ◽

Transanal Approach

AbstractMinimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as “no incision surgery,” represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.

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LARS is Associated with Lower Anastomoses, but not with the Transanal Approach in Patients Undergoing Rectal Cancer Resection

World Journal of Surgery ◽

10.1007/s00268-020-05876-6 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alexandra Filips ◽

Tobias Haltmeier ◽

Andreas Kohler ◽

Daniel Candinas ◽

Lukas Brügger ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Functional Outcomes ◽

Low Anterior Resection ◽

Regression Coefficient ◽

Anal Verge ◽

Transanal Approach ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

The Impact

Abstract Background Low anterior resection syndrome (LARS) is a defecation disorder that frequently occurs after a low anterior resection (LAR) with a total mesorectal excision (TME). The transanal (ta) TME for low rectal pathologies could potentially overcome some of the difficulties encountered with the abdominal approach in a narrow pelvis. However, the impact of the transanal approach on functional outcomes remains unknown. Here, we investigated the effect of the taTME approach on functional outcomes by comparing LARS scores between the LAR and taTME approaches in patients with colorectal cancer. Methods We conducted a retrospective cohort study including 80 patients (n = 40 LAR-TME, n = 40 taTME) with rectal adenocarcinoma. We reviewed medical charts to obtain LARS scores 6 months after the rectal resection or a reversal of the protective ileostomy. Results At the 6-month follow-up, 80% of patients exhibited LARS symptoms (44% minor LARS and 36% major LARS). LARS scores were not significantly associated with the T-stage, N-stage, or neo-adjuvant radiotherapy. The mean distance of the anastomosis from the anal verge was 4.0 ± 2.0 cm. The taTME group had significantly lower anastomoses compared with the LAR-TME group (median 4.0 cm [IQR1.8] vs. median 5.0 cm [IQR 2.0], p < 0.001). Univariable analysis revealed significantly higher LARS scores in the taTME group compared with the LAR-TME group (median LARS scores: 29 vs. 25, p = 0.040). However, multivariable regression analysis, adjusting for neo-adjuvant treatment, anastomosis distance from the anal verge, anastomotic leak rate, and body mass index, revealed no significant effect of taTME on the LARS score (adjusted regression coefficient: − 2.147, 95%CI: − 2.130 to 6.169, p = 0.359). We also found a significant correlation between LARS scores and the distance of the anastomosis from the anal verge (regression coefficient: − 1.145, 95%CI: − 2.149 to − 1.141, p = 0.026). Conclusion Fifty percentage of patients in this cohort exhibited some LARS symptoms after a mid- or low-rectal cancer resection. As previously described, LARS scores were negatively correlated with the distance of the anastomosis from the anal verge. TaTME was after adjustment for the height of the anastomosis not associated with higher LARS at 6 months when compared with LAR-TME.

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