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Operative Technique
December 1, 2005

Transanal Endoscopic Repair of Rectal Anastomotic Defect

Author Affiliations

Author Affiliations: Division of Surgical Oncology, Department of Surgery, Loma Linda University Medical Center and Loma Linda VA Healthcare System, Loma Linda, Calif.



Arch Surg. 2005;140(12):1219-1222. doi:10.1001/archsurg.140.12.1219

Surgeons often encounter difficulty when constructing a colorectal anastomosis in the “hostile pelvis.” Examples include performing low anterior resection or colostomy takedown in the setting of prior radiation, severe inflammation, or a narrow pelvis. Circular staplers have made low anastomosis a viable alternative to permanent colostomy in these situations. However, the surgeon may occasionally be faced with the difficult decision of how to manage a gross disruption of a stapled anastomosis in a pelvis that will not permit anastomotic redo. The traditional approach to this would be creating a permanent colostomy. We describe an alternate approach: endoscopic suturing with protecting ileostomy. We have successfully applied this technique to 4 patients with gross anastomotic disruption in a hostile pelvis. All patients tolerated the procedure well and have maintained normal bowel function without the need for a permanent colostomy.