D'Ambrosio Giancarlo, Lamazza Antonietta, Palma Rossella, Picchetto Andrea, Panetta Cristina, Trecca Antonello, Pontone Stefano, Lezoche Emanuele
Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy.
Department of Surgery, Istituto Pietro Valdoni, Sapienza University of Rome, Rome, Italy.
Ann Coloproctol. 2020 Aug;36(4):285-288. doi: 10.3393/ac.2019.09.30.3. Epub 2020 Mar 16.
Transanal endoscopic microsurgery (TEM) is a type of natural orifice transluminal endoscopic surgery, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36-year-old woman with a diagnosis of Hirschsprung disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of preanastomotic colon (proximal colon from the anastomosis) was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM-colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique.
经肛门内镜显微手术（TEM）是一种自然腔道内镜手术，专为直肠肿瘤而开发，也用于治疗其他直肠疾病。结直肠手术后的吻合口并发症，包括狭窄，是一个具有挑战性的问题。我们报告一例36岁诊断为先天性巨结肠的女性患者，其接受了改良的杜哈梅尔手术。术后钡剂灌肠显示吻合口完全狭窄，无法通过柔性内镜方法解决。然后通过小的结肠切开术进行术中内镜检查，以促进吻合口前结肠（吻合口近端结肠）的定位，并在荧光内镜控制下通过TEM创建新的吻合口实现结肠再通。患者接受了钡剂灌肠复查，显示造影剂逆行通过正常，无狭窄迹象。根据我们的经验，TEM结肠镜辅助经肛门入路是安全可行的，代表了一种微创技术联合的模式。
