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TAMIS (TRANSANAL MINIMALLY INVASIVE SURGERY) IS FEASIBLE FOR TREATMENT OF LOW COLORECTAL ANASTOMOTIC LEAK - EXPERIMENTAL STUDY.
Jaroslav Kalvach*1,2, Ondrej Ryska3,2, Jaroslav Pazin2,1, Jan Hadac2,1, Stefan Juhas2, Jana Juhasova2, Jan Martinek4,2
1Military University Hospital Prague, Prague, Czechia; 2Institute of animal Physiology and Genetics Czech Academy of Science, Libechov, Czechia; 3University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom; 4Institute for Clinical and Experimental Medicine, Prague, Czechia
Introduction
Anastomotic leak (AL) after low anterior resection remains one of the most serious complications. Transanal minimally invasive surgery (TAMIS) has been recently introduced not only for procedures in the rectum but also as an alternative approach to mesorectal excision. This technique can be suitable for the treatment of early diagnosed AL.
The aim of our experimental study was to evaluate the feasibility of TAMIS for transanal repair of early diagnosed low colorectal anastomotic leak. Secondary aim was to evaluate whether this technique prevents intraabdominal sepsis.
Methods
Model of low colorectal anastomotic leak was introduced in 20 male pigs. Standard laparoscopic low anterior resection was performed and the anastomosis created with 28 mm circular stapler after removing half of the staples.
Ten pigs had an anastomotic repair using TAMIS technique 3 days later. GelPOINT (AppliedMedical, CA, USA) port was inserted transanally, pneumorectum (15-20mmHg) established and 5mm camera together with Johan forceps and laparoscopic needle holder used. Anastomotic defect was closed with interrupted 3/0 vicryl suture. Ten animals with no treatment were included in control group.
Animals were sacrificed and autopsied on 9th postoperative day to assess signs of intraabdominal sepsis and visible anastomotic dehiscence. The closure was tested using standardized burst test. Chi square test was used to compare both groups.
Protocol was approved by local ethical committee in accordance with the European Convention on Animal Protection.
Results
There was no postoperative mortality. The closure with TAMIS was technically feasible in all 10 cases with mean procedure time of 48.4 (20-70)min. At the autopsy, anastomotic defect was visible in 4/10 and 8/10 (p=0,07) animals in TAMIS and control group respectively. There was a trend towards higher rate of intraabdominal abscesses (4/10 vs. 7/10), and purulent or faecal peritoneal fluid (2/10 vs. 4/10) in control group. The burst test performed in 6 TAMIS cases confirmed sufficient closure with mean pressure of 235 (25-300) mmHg.
Conclusion
TAMIS is technically feasible for repair of early diagnosed low colorectal anastomotic leak.
This technique reduced the rate of intraabdominal septic complications, however this did not reach statistical significance.
Supported by AZV 16-31806A, MO 1012.
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