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Scientific Articles

Transanal total mesorectal excision (TaTME) for inflammatory bowel disease (IBD): review of technique and initial experience

Authors:

Pramodh Chandrasinghe ,

University of Kelaniya, LK
About Pramodh

Department of Surgery, Faculty of Medicine

 

Department of Colorectal Surgery, St.Mark's Hospital, United Kingdom, HA1 3UJ

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Raimund Strouhal,

St.Mark's Hospital, HA1 3UJ, GB
About Raimund
Department of Colorectal Surgery
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Narasimhaiah Srinivasaiah,

St.Mark's Hospital, HA1 3UJ, GB
About Narasimhaiah
Department of Colorectal Surgery
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Cosimo Alex Leo,

St.Mark's Hospital, HA1 3UJ, GB
About Cosimo Alex
Department of Colorectal Surgery
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Sanjeev Samaranayake,

St.Mark's Hospital, HA1 3UJ, GB
About Sanjeev
Department of Colorectal Surgery
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Janindra Warusavitarne

St.Mark's Hospital, HA1 3UJ, GB
About Janindra
Department of Colorectal Surgery
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Abstract

Introduction

Trans anal minimal invasive surgery (TAMIS) is a novel technique gaining popularity in colorectal surgery due to its precision in pelvic dissection and easy accessibility to the distal rectum. Its use in colorectal cancer surgery is well documented although inflammatory bowel disease (IBD) poses a unique set of disease-specific and procedure-related challenges. Unlike in cancer surgery, the wide disease spectrum with varying morphological changes in IBD would require the surgeon to adapt accordingly from port insertion to wound closure. This article describes our experience with the first 60 procedures.

 

Methodology

Patients affected by IBD requiring proctectomy with or without total colectomy from 2013 to 2016 were offered Trans anal total mesorectal excision (TaTME) on a TAMIS and Single Incision Laparoscopy (SILS) combined platform. Airseal ® insufflation on GelpointPath ® platform with monopolar diathermy was used for rectal surgery. A second team using ultrasonic dissection carried out concomitant abdominal dissection. Procedural modifications were adopted based on authors' personal experience. Standard ileoanal S pouch with stapler anastomosis was performed. Surgical time, blood loss and patient demographics were recorded.

 

Results

All 60 patients (male – 44; median age 42.5; range 19-75) presented during the study period underwent TaTME for the rectal dissection with an 8% conversion rate. Of the total 38 (63%) were done for ulcerative colitis and the perineal phase has taken a median time of 141.8 minutes. Ileo-anal pouch surgery was performed in 27 (45%) patients. Two patients (3.3%) required re-intervention due to complications in the abdominal procedure. Two patients required vacuum dressing for wound closure.

 

Conclusion

TaTME is a safe and feasible procedure in IBD surgery. Specific difficulties due to the inflammatory process which results in difficult dissection can be overcome with attention to anatomical details and the use of specific instruments.
How to Cite: Chandrasinghe, P. et al., (2017). Transanal total mesorectal excision (TaTME) for inflammatory bowel disease (IBD): review of technique and initial experience. Sri Lanka Journal of Surgery. 35(4), pp.3–7. DOI: http://doi.org/10.4038/sljs.v35i4.8431
Published on 29 Dec 2017.
Peer Reviewed

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