Antonio M Lacy (Director of Department of Gastrointestinal Surgery)
Marta Jiménez (Gastrointestinal Surgery Specialist)
Hospital Clínic, Barcelona, Spain
A 65-year-old male with the diagnosis of cT3N1 rectal tumor at 7 cm from the anal verge underwent neoadjuvant therapy and low anterior resection by laparoscopy with a diverting stoma. In the postoperative period suffered from a symptomatic leakage treated with a drainage and antibiotics.
At the follow up the water soluble enema was normal and the gastrointestinal transit was restored by reverting the ileostomy. Three months, after a presented fever and sacral pain appeared, a sinus was identified with a CT Scan. A diverting colostomy was made, but the symptoms persisted.
The height of the lesion was 5 cm from the anal verge, a transanal approach was attempted with a GelPOINT Path that allows the use of two working channels (regular laparoscopic instruments) and a 3D camera with a flexible tip.
The endoluminal examination revealed an edematous rectal mucosa with a defect at the posterior wall of the rectum. The hook was used for dissection, there is a small working space so movements must be delicate. The main limitation during the procedure is the smoke.
The aims of the procedure are to resect fibrosis and achieve enough healthy tissue to built a flap and seal the defect. This was accomplished with endoluminal knots of prolene.
There was no complications at the postoperative period, the patient’s symptoms were solved and he is waiting for the closure of the colostomy.