Transanal Endoscopic Surgical Proctectomy for Proctitis Case Series Report: Diversion, Radiation, Ulcerative Colitis, and Crohn’s Disease – Pages 51-57

Elisabeth C. McLemore1, Hyuma Leland1, Bikash Devaraj1, Suresh Pola2, Michael J. Docherty2, Derek R. Patel2, Barrett G. Levesque2, William J. Sandborn2, Mark A. Talamini1, Sonia L. Ramamoorthy1

1The University of California, San Diego, Department of Surgery, USA; 2The University of California, San Diego, Department of Gastroenterology, USA

DOI: http://dx.doi.org/10.12970/2308-6483.2013.01.01.8

Download PDF

Abstract: Background: With recent trends in natural orifice surgery, there has been a rising interest in the evolution of transanal endoscopic surgery (TES) and transanal access platforms. Transanal endoluminal removal of rectal masses has matured into transanal endoscopic surgical resection of the rectum for benign and malignant disease. The purpose of this study is to evaluate the surgical outcomes of TES completion proctectomy in patients with proctitis in a retained rectum.

Methods: This is a retrospective case series report. Patient demographics and peri-operative outcome variables were recorded.

Results: TES proctectomy was successfully performed in 6 patients using a disposable transanal access platform. The patient’s ages ranged from 22 – 74 years, 4 women and 2 men, BMI ranged from 22 – 51 kg/m2. The indication for surgery was proctitis in a retained rectum: diversion (n=1), radiation (n=1), ulcerative colitis (n=2), and Crohn’s disease (n=2). Four applications of TES proctectomy were employed: TES completion proctectomy (n=2), TES assisted single incision abdominal perineal resection (n=1), TES assisted laparoscopic restorative proctectomy with colo-anal anastomosis (n=1), and TES assisted laparoscopic restorative total proctocolectomy with ileal pouch anal anastomosis (n=1). The operative time for TES completion proctectomy ranged from 140 – 238 minutes (n=4). The operative time for TES restorative proctectomy was longer at 446 min and 557 min (n=2). The hospital length of stay for both TES completion and restorative proctectomy ranged from 2 – 5 days (n=5). Complications included 1 urinary tract infection, 1 chronic draining perineal sinus tract, and 1 perineal wound dehiscence requiring re-operation. All six patients are doing well at the time of follow up (range 3 – 19 months).

Conclusions: TES completion proctectomy alone or in combination with laparoscopic abdominal surgery is a safe and effective method to perform proctectomy and restorative proctectomy in this small case series of patients with proctitis in a retained rectum due to diversion, radiation, ulcerative colitis, and Crohn’s disease.

Keywords: TES, TAMIS, Completion Proctectomy, Ulcerative Colitis, Proctitis, Regional Proctitis, Crohn’s Disease, Radiation Proctitis, Natural Orifice Surgery, Transanal Endoscopic Surgery. Read more