Minimally Invasive Treatment of a Completely Obstructed Rectal Anastomosis by Using a Transanal Plasmakinetic Resectosco
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REVIEW ARTICLE
Minimally Invasive Treatment of a Completely Obstructed Rectal Anastomosis by Using a Transanal Plasmakinetic Resectoscope: a Case Report and Review of Literature Na Wang 1 & Daguang Wang 2 & Weihua Tong 2 & Jinguo Wang 3 Received: 5 October 2020 / Accepted: 11 November 2020 # Association of Surgeons of India 2020
Abstract We present a case of successful minimally invasive treatment of a completely obstructed rectal anastomosis by using a transanal plasmakinetic resectoscope, along with a review of the relevant literature. A 75-year-old man underwent low anterior resection for rectal cancer. Complete obstruction of the rectal anastomosis was visualized at 6.0 cm from the anal verge, 5 months later. We carefully cut at the center of the circular staple line to find the orifice of anastomosis with a plasmakinetic resectoscope. Then, a sufficient amount of fibrotic tissue at the stenosis was resected to maintain the continuity of the bowel. At 4 months follow-up, the patient had complete resolution of symptoms. Transanal plasmakinetic resection is a possible choice for treatment of a completely obstructed colorectal anastomosis. However, these techniques have risks and should be implemented with great caution in selected patients by skilled endoscopists or surgeons. Keywords Transanal plasmakinetic resectoscope . Completely obstruction . Colorectal anastomosis
Background Benign anastomotic stenosis occurs in up to 22% of patients after lower rectal surgeries for rectal cancer [1]. However, completely obstructed anastomosis after rectal resection is rare, so the treatment measures depend on each individual’s situation [2–12]. Completely obstructed anastomosis normally needs conventional redo surgery, but redo surgery is
invasive and does not eliminate the risk of recurrence [1, 2, 13]. Thus, modified minimally invasive treatment strategy is attractive, and it has been successfully performed in some cases [3–12]. Plasmakinetic resectoscope is widely used for transurethral resection of prostate. Here, we discuss a case of a completely obstructed anastomosis after low anterior resection (LAR), which has been successfully treated utilizing transanal plasmakinetic resection of massive scar tissue in the anastomotic site, together with a review of the relevant literature.
* Jinguo Wang [email protected] Na Wang [email protected] Daguang Wang [email protected] Weihua Tong [email protected] 1
Department of Anesthesiology, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, China
2
Department of Gastrointestinal Surgery, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun 130021, China
3
Department of Urology, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, Jilin 130021, China
Case Report A 75-year-old man underwent LAR for rectal cancer. Three months later, he developed an anastomotic stenosis due to postoperative leakage and pelvic infection, and then endoscopic balloon dilatation was performed several times with minimal success
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