What does this paper add to the literature?
Methods
Surgical technique
Statistical analysis
Results
Patient characteristics
Underlying disease | Indication for TAMIS | Number of interventions prior to TAMISa
| Type of interventions prior to TAMIS | |
---|---|---|---|---|
Anastomotic problems: 13/17(76 %) | ||||
1 |
Carcinoma
| Presacral abscess | 4 | LAR (laparoscopic), endosponge, Transanal closure of defect, endosponge |
2 |
Carcinoma
| Stenosis of anastomosis | 1 | LAR (laparoscopic) |
3 |
Carcinoma
| Presacral sinus | 4 | LAR (open), relaparotomy, ileostomy closure, endosponge |
4 |
Carcinoma
| Presacral sinus | 3 | LAR (open), Ileostomy closure, relaparotomy with formation of new anastomosis |
5 |
Carcinoma
| Presacral sinus | 5 | LAR(laparoscopic), transanastomotic drain, ileostomy closure, endosponge, transanal closure of anastomotic defect. |
6 |
Carcinoma
| Presacral sinus | 3 | LAR (laparoscopic), endosponge, transanal closure of defect |
7 |
Carcinoma
| Presacral sinus | 1 | LAR (open) |
8 |
Carcinoma
| Presacral sinus | 2 | LAR (open), percutaneous abscess drainage. |
9 |
Carcinoma
| Presacral sinus presenting as a rectovaginal fistula | 5 | LAR (open), ileostomy closure, ileostomy formation due to leaking blind loop, JJ-Catheter placement, ileostomy closure |
10 |
Carcinoma
| Presacral sinus with enterocutaneous and small bowel fistula and an anastomotic stenosis | 8 | LAR (open), Ileostomy closure, trocar herniation correction, relaparotomy due to ileus, resection leaking anastomosis and end colostomy, parastomal hernia correction, surgically placed abdominal drain, endosponge |
11 |
Ulcerative colitis
| Presacral sinus presenting as a pouch fistula | 22 | Subtotal colectomy (open), relaparotomy+ ileostomy formation, ileostomy closure, proctectomy, relaparotomy, angiogram with coiling (2×), abdominal mesh placement, relaparotomy, Percutaneous drainage, endosponge, revision abdominal mesh + VAC abdomen, endosponge, transanal pouch revision, endosponge, transanal pouch revision, ramirez-plasty + pouch excision and formation new pouch, transanal closure anastomotic leakage, endosponge, transanal closure anastomotic leakage, endosponge, transanal closure anastomotic leakage |
12 |
Ulcerative colitis
| Presacral sinus presenting as a perianal fistula and cuffitis | 3 | Subtotal colectomy with J-pouch (laparoscopic), proctectomy, ileostomy closure, mesh removal + closure abdominal wall, relaparotomy + VAC abdomen, transanal pouch revision (2×), |
13 |
Ulcerative colitis
| Dehiscence of the posterior part of the IPAA | 4 | Subtotal colectomy without anastomosis (open), secondary IPAA, shortening of blind loop and formation of new IPAA, ileostomy formation |
Pouch problems: 4/17 (23 %) | ||||
14 |
Ulcerative colitis
| Efferent loop syndrome | 6 | Subtotal colectomy with J-pouch (open), Correction of abdominal scar, endoscopic dilation of anastomosis (4×) |
15 |
FAP
| Obstructive polyp on pouch | 6 | Subtotal colectomy with J-pouch (open), partial jejunal resection, proctectomy, relaparotomy with formation ileostomy, ileostomy closure, transanal pouch revision |
16 |
Ulcerative colitis
| Voiding disorder pouch | 2 | Subtotal colectomy without anastomosis (open), secondary IPAA, |
17 |
Ulcerative colitis
| Ulcer on pouch leading to recurrent cuffitis | 3 | Proctocolectomy due to pancolitis (laparoscopic), ileostomy closure |
N = 17 | |
---|---|
Gender
| |
Males (n, %) | 10 (58) |
Age
| |
Median age (years, range) | 56 (30–67) |
ASA
| |
I (n, %) | 3 (18) |
II (n, %) | 13 (76) |
III (n, %) | 1 (6) |
BMI
| |
Median BMI (range) | 23.4 (18.6–33.6) |
Neo-adjuvant treatment
| |
Any neo-adjuvant treatment (n, %) | 10 (59) |
Short course 5 × 5 Gy (n, %) | 4 (24) |
Long course with concomitant chemotherapy (n, %) | 6 (35) |
Primary surgery
| |
Low Anterior Resection with diverting ileostomy (n, %) | 10 (59) |
Proctocolectomy with IPAA (n, %) | 7 (42) |
Approach of primary surgery
| |
Open | 11 (65) |
Laparoscopic | 6 (35) |
Time interval
| |
Median Time Between Initial Procedure-TAMIS (Months, range) | 49 (11–372) |
Earlier interventions
| |
Median number of interventions prior to TAMIS | 3 (1–21) |
Of which Surgical (median, range) | 61/82 (74 %) |
Of which Radiological (median, range) | 5/82 (6 %) |
Of which Endoscopic (median, range) | 16/82 (20 %) |
Indications for redo anastomotic surgery
Surgical outcomes
Operative outcomes
Postoperative outcomes
Length of in hospital stay (median, range) | 8 (4–23) |
Any Postoperative complications (within 30 days) | 9 (53) |
Clavien–Dindo III or higher | 7 (41) |
Anastomotic Leakage (n, %) | 2 (14) |
Occult leakage (Abdominal abscess) | 4 (24) |
Ileus (n, %) | 2 (12) |
Urethra stenosis | 1 (6) |
Dehydration | 1 (6) |
Readmissions (within 30 days) | 5 (29) |
Cause readmission: | |
Anastomotic leakage: | 2 |
Abdominal abscess | 1 |
ileus | 1 |
Dehydration | 1 |
Continuity at 6 months post redo-TAMIS | 10 (71 %) |
Postoperative complications from 30 days to 6 months
| 3 (18 %) |
Faecal incontinence requiring diverting ileostomy | |
Recurrent presacral abscess following stoma closure requiring new ileostomy and prolonged endosponge treatment | |
Delayed anastomotic leakage (32 days post-TAMIS) | |
Complications following stoma closure
| 2 (22 %) |
Recurrent presacral abscess | |
Postoperative anaemia requiring blood transfusion | |
Length of follow-up (median, months)
| 9 (6–15) |