Dapri G, Guta D, Grozdev K, Antolino L, Bachir N, Jottard K, Cadière G-B
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Colorectal Dis. 2016 Jun;18(6):O210-3. doi: 10.1111/codi.13358.
Interest in transanal laparoscopy has increased in the last decade. This approach can allow primary procedures such as polypectomy, total mesorectal excision and the treatment of postoperative complications such as bleeding, leakage and fistula formation.
Two patients treated by transanal repair for leakage of a colorectal anastomosis after laparoscopic anterior resection of the rectum are reported. The first developed leakage immediately during the surgery and in the second leakage presented at 4 weeks. A new transanal platform according to DAPRI (Karl Storz-Endoskope, Tuttlingen, Germany), formed by a reusable port and reusable monocurved instruments was developed to permit manipulation of sutures introduced via the anus in a maximally ergonomic manner. Laparoscopic suturing was performed transanally and a protective ileostomy was added as well.
The transanal procedures took 60 and 45 min and the patients were discharged after 5 days and 2 days. At 2 months both defects were found to be healed on contrast radiology and endoscopy; therefore the ileostomy was closed. Anal function was satisfactory with a frequency of two and one times per 24 h with no incontinence or evidence of sepsis.
Intra-operative or late leakage of colorectal anastomosis can be safely treated by transanal laparoscopy. This new transanal platform offers the surgeon the possibility to work in ergonomic positions, without increasing the cost of the procedure thanks to the reusable nature of the material used.
在过去十年中，经肛门腹腔镜检查的关注度有所增加。这种方法可以进行诸如息肉切除术、全直肠系膜切除术等主要手术，以及治疗诸如出血、渗漏和瘘管形成等术后并发症。
报告了两例在腹腔镜直肠前切除术后经肛门修复大肠吻合口渗漏的患者。第一例在手术期间立即出现渗漏，第二例在4周时出现渗漏。开发了一种根据DAPRI（德国图特林根的卡尔·史托斯内窥镜公司）设计的新型经肛门平台，该平台由一个可重复使用的端口和可重复使用的单弯器械组成，以允许以最大程度符合人体工程学的方式操作经肛门引入的缝线。经肛门进行腹腔镜缝合，并增加了保护性回肠造口术。
经肛门手术分别耗时60分钟和45分钟，患者分别在5天和2天后出院。在2个月时，造影检查和内窥镜检查发现两个缺损均已愈合；因此关闭了回肠造口术。肛门功能令人满意，每24小时排便次数分别为两次和一次，无失禁或败血症迹象。
大肠吻合口术中或术后晚期渗漏可通过经肛门腹腔镜检查安全治疗。这种新型经肛门平台为外科医生提供了在符合人体工程学的位置工作的可能性，由于所用材料的可重复使用性，不会增加手术成本。
