Transanal minimally invasive surgery to rescue anastomosis following leak after low anterior resection: A case report

Restorative low anterior resection (LAR) for rectal cancer carries a significant risk of anastomotic leak: One of the most feared complications in colorectal surgery. Operative management may include takedown of the anastomosis and end colostomy which, in some cases, is permanent. Other contemporary operative measures include over the scope clips and Endosponge. Recently, there have been case reports and a Society of American Endoscopic and Gastrointestinal Surgeons video on the novel use of transanal minimally invasive surgery (TAMIS) in the management of anastomotic leak. We present a 59-year-old female who underwent LAR after declining radiotherapy for a bulky 9 cm rectal tumour 9–10 cm from the anal verge. Following clinical deterioration, computed tomography demonstrated an anastomotic leak communicating with a 5-cm pelvic collection containing gas. At laparoscopy, pus and faeculent material were washed from the pelvic cavity and drains were placed. Intra-operative endoscopy demonstrated a 7–8 mm dehiscence at the anastomosis. The defect (approximately 7 cm from the anal verge) was successfully closed using TAMIS and a running V-lock suture. The patient recovered well and was discharged home on post-operative day 20. In this case, a low colorectal anastomotic leak was successfully rescued with TAMIS. This novel technique may be useful in the armamentarium of colorectal surgeons experienced in TAMIS.