Rectal eversion and double-stapled ileal pouch anal anastomosis in familial adenomatous polyposis syndrome

Abstract

INTRODUCTIONSurgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique.PRESENTATION OF CASEA 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal.DISCUSSIONThere is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients.CONCLUSIONJ-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients.

A modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection for upper rectal or lower sigmoid colon cancer: a retrospective study

“…Based on the advantages of laparoscopy, the combination of laparoscopy and NOTES, such as natural orifice specimen extraction surgery (NOSES), has become a field of special interest for researchers worldwide. For example, rectal eversion-resection has been reported by many researchers [12,13,19]. The procedure is mainly used for patients who need anterior resection for high or middle rectal cancer.…”

“…However, the scar on the abdomen caused by this procedure may cause dissatisfaction in some patients. In recent years, some researchers have reported transanal specimen extraction in laparoscopic anterior rectal resection [6][7][8], including intersphincteric resection (ISR) [9][10][11], and rectal eversion-resection [12,13]. However these surgical procedures have certain limitations.…”