Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan.
World J Surg Oncol. 2019 Mar 14;17(1):48. doi: 10.1186/s12957-019-1592-x.
Development of an anastomotic stricture following rectal cancer surgery is not uncommon. Such strictures are usually managed by manual or instrumental dilatation techniques that are often insufficiently effective, as evidenced by the high recurrence rate. Various surgical procedures using minimally invasive approaches have also been reported. One of these procedures, endoscopic radial incision and cutting (RIC), has been extensively reported. However, RIC by transanal minimally invasive surgery (TAMIS) is yet to be reported. We here report a novel application of TAMIS for performing RIC for anastomotic rectal stenosis.
A 67-year-old man had suffered from constipation for 6 years after undergoing low anterior resection for stage II rectal cancer 7 years ago. Colonoscopy showed a 1-cm diameter stricture in the lower rectum. Balloon dilatation was performed many times because of repeated recurrences. Thus, surgical management was considered and the stricture was successfully excised via a RIC method using a TAMIS approach. Postoperatively, the patient had minimal leakage that resolved with conservative treatment.
A RIC method using a TAMIS approach is an effective minimally invasive means of managing anastomotic strictures following rectal cancer surgery.
直肠癌手术后吻合口狭窄并不罕见。这些狭窄通常通过手动或器械扩张技术来治疗，但效果往往不够理想，因为复发率很高。也有报道采用微创方法的各种手术。其中一种方法，经肛门内镜下的放射状切开术（endoscopic radial incision and cutting，RIC）已被广泛报道。然而，经肛门微创外科（transanal minimally invasive surgery，TAMIS）下的 RIC 尚未有报道。我们在此报告一种 TAMIS 用于治疗吻合口直肠狭窄的 RIC 的新应用。
一名 67 岁男性，7 年前因 II 期直肠癌行低位前切除术，术后 6 年来一直便秘。结肠镜检查显示下段直肠有 1cm 直径的狭窄。由于反复复发，进行了多次球囊扩张。因此，考虑手术治疗，通过 TAMIS 途径的 RIC 方法成功切除狭窄。术后，患者有轻微漏液，经保守治疗后缓解。
TAMIS 下的 RIC 方法是治疗直肠癌术后吻合口狭窄的一种有效微创手段。
