Introduction
The management of postoperative anastomotic stenosis after rectal cancer surgery remains a significant challenge, often resulting laparotomy or permanent ostomy. While Hegar dilators and endoscopic balloon dilation are effective for partial stenoses, they are not applicable in cases of complete occlusion. The selective use of magnetic rings has been proposed as a potential treatment; however, their availability is limited. As an alternative, a transillumination-guided laparoscopic needle-assisted endoscopic and transanal recanalization technique can be employed in patients with total anastomotic stenosis following low anterior resection (LAR).
Case
A 56-year-old male, who had undergone LAR with sigmoid loop colostomy for rectal cancer 9 months prior, presented with rectal stenosis. His postoperative course included adjuvant radiotherapy followed by chemotherapy. Colonoscopy revealed a complete stenosis at 6 cm from the anal verge, and histopathological examination confirmed a benign etiology.
The patient was positioned in modified lithotomy, and the Lone Star® Retractor System (CooperSurgical, Trumbull, CT, USA) was applied along with an anal retractor. A colonoscope was introduced through the distal segment of the sigmoid colostomy. Under transillumination guidance, a laparoscopic needle was advanced through the stenotic segment to establish an initial opening. The opening was subsequently enlarged using an electrocautery tip, positioned between the jaws of a grasper inserted through the created fenestration. The lumen was further dilated using a Foley catheter balloon (5–10 mL inflation) followed by sequential Hegar dilators (14 Fr to 18 Fr). Finally, a fully covered self-expandable metal stent was deployed to maintain luminal patency.
Outcomes
The procedure was completed in 48 min with minimal blood loss. The patient was discharged on postoperative day 2 without tenesmus or other complications. At 1 month postoperatively, the stent was removed, revealing well-healed bowel mucosa and an adequate luminal patency. Colostomy reversal was subsequently performed with an uneventful postoperative course.
Conclusions
Transillumination-guided endoscopic and transanal recanalization is a safe and feasible approach for the management of total anastomotic stenosis following rectal cancer surgery. The selective utilization of this technique may reduce the need for laparotomy and/or permanent ostomy in selected patients.
Supplementary Information
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Acknowledgements
Ege University have open access funding agreements with Springer Nature. As an author at Ege University we are asking to publish in Techniques in Coloproctology with 100% of the APC paid by our institution.
Author contribution
E.K. and K.E. have an equal contribution. E.K.: writing of the manuscript and video editing. K.E.: writing of the manuscript, video editing, and reviewing. O.B.: reviewing, supervision, and methodology.
Funding
This study was not sponsor-funded.
Data availability
No datasets were generated or analyzed during the current study.
Declarations
Conflict of interest
The authors have no conflicts of interest or financial ties to disclose.
Informed consent
Informed consent was obtained.
Footnotes
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Supplementary Materials
Data Availability Statement
No datasets were generated or analyzed during the current study.