Anastomotic leakage of a colorectal anastomosis treated by transanal endoscopic microsurgery.

OBJECTIVE: To report a minimal invasive technique for repairing an anastomotic leakage with Transanal Endoscopic Microsurgery (T.E.M.) without creating a protective ostomy.
SUMMARY: There are a large number of techniques for the management of anastomotic leakage after colorectal surgery. Depending on the size and location of the disruption, a protective ileostomy, a permanent colostomy or even reintervention for drainage or closure of the leak may be indicated. In most cases the patient faces the morbidity associated with a new intervention, a prolonged hospital stay and a future operation for closure of the stoma. In the present case a 56-year-old man underwent a laparoscopic rectosigmoid resection after two episodes of diverticulitis in six months. An end-to-end circular stapled anastomosis was constructed. Unfortunately 8-days postoperatively an anastomotic leak occurred. Attempts to close the tear non-surgically with colonoscopy and clipping failed. A minimally invasive reintervention with transanal endoscopic microsurgery (T.E.M.) was performed without creation of an ileostomy. One week postoperatively a gastrografin bowel study showed no leakage. To our knowledge, this technique has not yet been reported without the simultaneous construction of a stoma.
CONCLUSION: We describe a possible minimally invasive technique to avoid laparotomy and/or the creation of a derivative stoma in the management of anastomotic leakage. Hospital stay is not significantly prolonged, future reïntervention for closure of stoma is avoided and sphincter function is preserved.