Restorative proctectomy with colon pouch–anal anastomosis by laparoscopic transanal pull-through: an available option for low rectal cancer?

Abstract

The authors' experience supports use of the LTPT procedure with colonic pouch-anal anastomosis for selected lower rectal cancers with indications for a laparoscopic approach as an appropriate and reproducible surgical treatment.

Restorative proctectomy with colon pouch-anal anastomosis by laparoscopic transanal pull-through: An available option for low rectal cancer?

“…[1]. I congratulate the authors upon their work, which indeed confirmed a prior original technique that we published in Surgical Endoscopy in [2], and which we presented as a poster at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) meeting in Dallas, in April 2006.…”

Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model

“…However, the main intellectual innovation in our technique lies in its obviation of the daunting requirement to close the transcolonic passageway to the pelvis because the fecal flora, combined with the thin wall of the viscus, affords zero tolerance of any flaw in a prospective seal. Such a means of specimen delivery for extracorporeal resection is already a well-established laparoscopic maneuver shown to be consistent with good outcomes in clinical studies [16,17]. Although others also have shown localized sigmoidectomy to be technically achievable using TEM instrumentation in a cadaver model [18], many have been altogether dissuaded from using the transcolonic route at all [19][20][21].…”

Transanal division of the anorectal junction followed by laparoscopic low anterior resection and coloanal pouch anastomosis: A technique facilitated by a balloon port

“…[1] Variations in hybrid technique of laparoscopic low anterior resection and hand-sewn anastomosis have been described. [23]…”

“…found that transanal extraction of the specimen was associated with significant morbidity but there was no difference in either morbidity or functional outcome seen by Prete et al ., in their comparison of two cohorts who had either transanal extraction or minilaparotomy. [39] We avoid transanal delivery of specimen to prevent sphincter injury or stretch from traction on bulky mesorectum. This also avoids using the sigmoid for pouch creation, which has been associated with more anastomotic leaks and inferior function.…”