Format

Send to

Choose Destination
Dis Colon Rectum. 2014 Jan;57(1):105-9. doi: 10.1097/DCR.0000000000000008.

Dynamic article: transanal rectal excision: a pilot study.

Author information

1
Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium.

Abstract

BACKGROUND:

Laparoscopic total mesorectal excision can be difficult in a narrow pelvis. Transanal minimally invasive surgery allows the surgeon to mobilize the most distal part of the rectum by using a single port positioned in the anal canal.

OBJECTIVE:

We aim to assess the safety and feasibility of transanal rectal excision.

DESIGN AND SETTING:

This pilot study was conducted in a university hospital and tertiary colorectal referral center in Belgium.

PATIENTS:

Over a 12-month period, all consecutive patients with benign disease and ASA grade 3 patients with a rectal carcinoma who required either intersphincteric proctectomy or coloanal anastomosis were included.

INTERVENTION:

After intersphincteric dissection or sleeve mucosectomy, a single-access multichannel port was inserted into the anal canal. A transanal rectal excision was performed by using conventional laparoscopic instruments. The planes were developed as cephalad as possible, until the pouch of Douglas was opened. A laparoscopically assisted approach was used to gain bowel length and was used in patients who required proctectomy. In the case of a reconstruction, a handsewn coloanal anastomosis was made.

MAIN OUTCOME MEASURES:

Intraoperative challenges, conversion rate, operating time, blood loss, morbidity, and length of stay were assessed.

RESULTS:

Fourteen patients underwent a transanal rectal excision for both benign (9) and malignant (5) disease. In 11 patients (79%), laparoscopically assisted transanal minimally invasive rectal excision was performed. The median (range) transanal operating time was 55 (35-95) minutes. Intraoperative difficulties hindering dissection occurred in 5 patients and were due to inadequate exposure, rectal perforation, or fibrosis secondary to radiotherapy for prostate cancer. There was minimal postoperative morbidity, with a median follow-up of 6.3 (1.5-13.8) months. All patients were discharged within 14 days postoperatively, and there were no readmissions.

LIMITATIONS:

The study was limited by the small number of patients.

CONCLUSION:

Transanal rectal excision is safe and feasible and could be a promising technique to facilitate distal rectal mobilization (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A125).

PMID:
24316953
DOI:
10.1097/DCR.0000000000000008
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center