Brehant Olivier, Hanes Adina, Fuks David, Sabbagh Charles, Blanpain Sébastien, Brazier Franck, Regimbeau Jean-Marc
Department of Digestive Surgery, University Hospital of Amiens, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
Int J Colorectal Dis. 2009 Oct;24(10):1233-7. doi: 10.1007/s00384-009-0780-5. Epub 2009 Aug 5.
This report describes a technique for the treatment of patients with chronic pelvic anastomotic sinuses (AS) after low anastomosis for rectal cancer in which transanal stapled marsupialisation is performed.
We reviewed the clinical history of a 62-year-old patient who had a symptomatic chronic pelvic AS more than 6 months after stapled low colorectal side-to-end anastomosis with loop ileostomy for a stage II cancer of the mid rectum without preoperative radiochemotherapy. Pelvic abscess was recurrent three times after percutaneous drainage, operative transanal drainage, and treatment with fibrin glue and ileostomy closure. The fourth treatment was a marsupialisation of the AS. The marsupialisation consisted of a section of the common wall between the colon lumen and the AS. It was performed by transanal route under general anaesthesia with a laparoscopic stapler.
There was no intraoperative complication. The postoperative course was uneventful, and the patient was discharged without symptoms. At 3 months, the clinical examination was normal. Functional results were good without defecation disorders.
Marsupialisation with a stapler of a chronic AS after low anastomosis for rectal cancer is an effective and efficient technique. On the basis of our experience, we believe that it may be an alternative management of the chronic AS. It allows conservation of the anastomosis.
