Borstlap W A A, Harran N, Tanis P J, Bemelman W A
Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Department of Surgery, Donald Gordon Medical Centre, Johannesburg, South Africa.
Surg Endosc. 2016 Dec;30(12):5364-5371. doi: 10.1007/s00464-016-4889-7. Epub 2016 Apr 11.
The aim of this study was to report on the feasibility of transanal minimally invasive surgery (TAMIS) as a novel approach to redo colorectal or ileoanal anastomoses.
From October 2014, a prospective institutional database was created for all consecutive patients who underwent redo surgery by TAMIS for presacral sinus or anastomotic stenosis after low anterior resection or pouch-related problems following restorative proctocolectomy. Intra-operative feasibility, 30-day postoperative outcomes, intestinal continuity and complications after 6-month follow-up were evaluated.
Of 17 included patients, 14 underwent anastomotic reconstruction and three completion proctectomy. The median operation time was 265 min (range 201-413). A successful rendezvous with simultaneous transabdominal access was achieved in 15 patients, and the procedure was completed by TAMIS alone in two. Five patients were readmitted within 30 days (29 %). Two (14 %) patients developed an anastomotic leakage within 30 days and 4 (24 %) developed a pelvic abscess requiring reintervention. One patient developed an urethra stenosis and was managed with a suprapubic catheter. Median follow-up was 9 (6-15) months. Within 6-month follow-up, the redo-TAMIS 1 patient developed a delayed anastomotic leak and 1 patient had a recurrent presacral abscess after stoma closure. Intestinal continuity was reached in 71 % of the patients at 6-month follow-up.
TAMIS is a valuable approach in redo pelvic surgery, but is still associated with high complication rates related to the complexity of the underlying problem.
本研究旨在报告经肛门微创手术（TAMIS）作为一种重新进行结直肠或回肠肛管吻合术的新方法的可行性。
自2014年10月起，为所有因低位前切除术后骶前窦或吻合口狭窄或恢复性直肠结肠切除术后与贮袋相关问题而接受TAMIS再次手术的连续患者建立了一个前瞻性机构数据库。评估了术中可行性、术后30天的结果、肠道连续性以及6个月随访后的并发症。
17例纳入患者中，14例行吻合口重建，3例行根治性直肠切除术。中位手术时间为265分钟（范围201 - 413分钟）。15例患者通过经腹联合入路成功会师，2例仅通过TAMIS完成手术。5例患者在30天内再次入院（29%）。2例（14%）患者在30天内发生吻合口漏，4例（24%）发生盆腔脓肿需要再次干预。1例患者发生尿道狭窄，通过耻骨上导管处理。中位随访时间为9（6 - 15）个月。在6个月随访期间，1例再次TAMIS患者发生延迟性吻合口漏，1例患者在造口关闭后出现复发性骶前脓肿。6个月随访时，71%的患者恢复了肠道连续性。
TAMIS是再次盆腔手术中的一种有价值的方法，但仍与因潜在问题复杂性导致的高并发症发生率相关。
