VM26 - Colorectal Anastomosis Revision by TEM with Antegrade Colonoscopy Guidance Through Diverting Ileostomy After Complete Anastomotic Stenosis

Purpose/Background: This is the case of a 54-year-old female who presented with a complete stenosis of her colorectal anastomosis, following clinical leak. The patient had previously undergone laparoscopic anterior resection for a diverticular disease. She developed an early anastomotic leak, which required surgical drainage and diverting ileostomy. Two months postoperatively, the patient was referred to designated colorectal surgery center, after a non-crossable anastomotic stenosis had been diagnosed. Balloon dilation was attempted, but impossible due to the stenosis’ severity.

Methods/Interventions: This video features a colorectal anastomosis revision by TEM, directly guided by antegrade colonoscopy through a diverting ileostomy’s efferent limb. With a TEM setting, under direct visualization by colonoscopy, the occluded anastomosis was identified and broken through by cauterization. Once the intestinal lumen was opened wide enough, this new anastomosis was completed with two hemi-circumferential running barbed sutures. At the end of the procedure, the scope could easily pass through the freshly crafted anastomosis. No complications occurred.

Results/Outcomes: Three weeks postoperatively, the patient had a water-soluble enema. Official radiology report described adequate distention of new anastomosis, up to 6mm, with no stenotic effect. There was no leak. A non-significant amount of contrast appeared to be passing through a very small remnant opening of the old anastomosis.

Conclusion/Discussion: The patient is clinically well and awaiting stoma reversal surgery, with perioperative colonoscopy and concomitant anastomosis dilation.
TEM revision can be used successfully to address highly selected cases of anastomotic stenosis.