Transanal Endoscopic Microsurgery - Endoscopy assisted treatment of colorectal anastomotic stenosis

Transanal Endoscopic Microsurgery (TEM) is a type of NOTES, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36 year-old woman with a diagnosis of Hirschsprung Disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of pre-anastomotic colon was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM -Colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique.