Low anterior resection with transanal transection and single-stapled anastomosis: technical aspects and initial results.

BACKGROUND: Rectal cancer (RC) is a surgical challenge due to its technical complexity. The double-stapled (DS) technique, a standard for colorectal anastomosis, has been associated with notable drawbacks, including a high incidence of anastomotic leak (AL). Low anterior resection with transanal transection and single-stapled (TTSS) anastomosis has emerged to mitigate those drawbacks. METHODS: Observational study in which it described the technical aspects and results of the initial group of patients with medium-low RC undergoing elective laparoscopic total mesorectal excision (TME) and TTSS. RESULTS: Twenty-two patients were included in the series. Favourable postoperative outcomes with a median length of stay of 5 days and an AL incidence of 9.1%. Importantly, all patients achieved complete mesorectal excision with tumour-free margins, and no mortalities were reported. CONCLUSION: TTSS emerges as a promising alternative for patients with middle and lower rectal tumours, offering potential benefits in terms of morbidity reduction and oncological integrity compared with other techniques.

Laparoscopic Toupet Fundoplication After Roux-en-Y Gastric Bypass in Patient with Severe GERD.

BACKGROUND: Up to 22% of the patients, after laparoscopic Roux-en-Y gastric bypass (LRYGB) can complain about gastroesophageal reflux disease (GERD) symptoms, there is little evidence about the most effective treatment of this situation. MATERIALS AND METHOD: This video shows a laparoscopic reintervention after a LRYGB in a 42-year-old woman presenting with untreatable GERD. GERD was treated with maximum doses of PPIs with no effect on the symptoms; the patient had a 24-h pH and impedance manometry that showed an acid and non-acid reflux, and for that reason, we decided to perform a laparoscopic fundoplication. First, very dense adhesions of the greater omentum and the stomach to the parietal peritoneum and the left lobe of the liver are dissected. The gastric remnant is dissected from the pouch, and as the adhesions are very hard, we use a linear stapler device to definitely separate remnant from the pouch, then, short gastric vessels are taken down, to allow mobilization to the medial side of the patient, being careful to preserve the dorsal gastric artery branch of the splenic artery. A Toupet fundoplication is performed with the gastric remnant, and a crural repair is performed with Ethibond stitches reinforced with a polypropylene mesh. RESULTS: After 1 year from the surgery, the patient is asymptomatic, with a normal pH metry and barium swallow. CONCLUSIONS: The laparoscopic fundoplication [1] after a LRYGB is one feasible surgical option intervention, but it must be performed with experienced hands and in a hospital with bariatric/esophagogastric surgery unit, in those patients with severe GERD after LRYGB and with no response to medical treatment.

Laparoscopic Roux-en-Y Gastric Bypass After Open Vertical Banded Gastroplasty in Patient with Severe GERD.

This video shows a laparoscopic reintervention after an open, vertical banded gastroplasty in a 39-year-old woman presenting with untreatable GERD.