Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis.

Abstract

BACKGROUND:

Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis.

CASE PRESENTATION:

A 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double stapling technique or transanal hand-sewn anastomosis, but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis.

CONCLUSION:

Performing side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.

• Authors: Yosuke Tajima, Tsunekazu Hanai, Hidetoshi Katsuno, Koji Masumori, Yoshikazu Koide, Keigo Ashida, Hiroshi Matsuoka, Junichiro Hiro, Tomoyoshi Endo, Tadahiro Kamiya, Yongchol Chong, Kotaro Maeda, Ichiro Uyama
• Journal: World journal of surgical oncology (World J Surg Oncol) Vol. 19 Issue 1 Pg. 14 (Jan 13 2021) ISSN: 1477-7819 [Electronic] England
• PMID: 33441169 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Anal Canal (surgery)
• Anastomosis, Surgical
• Constriction, Pathologic (surgery)
• Female
• Humans
• Laparoscopy
• Prognosis
• Rectal Neoplasms (surgery)
• Rectum (surgery)
• Robotic Surgical Procedures
• Surgical Stapling