XXXX after laparoscopic single-port sigmoid resection: combined transanal and transabdominal minimal invasive management.

@entity1 @entity834 @entity254 @entity298 @entity34
BACKGROUND: Laparoscopic colorectal surgery has become the gold standard in the therapy of benignant and malignant colorectal pathologies. @entity834 is still a reason for laparotomy; applying a diverting stoma or performing a Hartman's procedure is common [1, 2]. Laparoscopic treatment of an early-detected @entity834 is suggested from other authors [3, 4]. In our video we demonstrate a combined minimal invasive transabdominal and transanal treatment concept in @entity1 with early-detected @entity834 . METHODS: Two consecutive @entity1 developing an @entity834 after single-port laparoscopic sigmoid resection for @entity34 (Hanson _ Stock) were treated with a combined minimal invasive approach. @entity834 was diagnosed by triple contrast computed tomography on postoperative day 4 in @entity1 one and on postoperative day 7 in @entity1 two. Operative treatment was performed immediately on the same day without delay. RESULTS: In both @entity1 a combined transanal and transabdominal approach was performed. First step was a diagnostic laparoscopy in order to exclude @entity298 . Using a single-port device (SILS    Port Covidien   ), transanal inspection of the @entity254 was also performed: In both @entity1 anastomotic tissue margins were vital, and the leakage affected only a quarter of the anastomotic circumference. Transanal stitches were placed to close the @entity834 . Laparoscopic transabdominal irrigation was performed, and two suction drainages were placed in the pelvis. Postoperative antibiotic treatment and a gradual return to slid food were carried out. Functional result at follow-up of 102 and 112  days (with rectoscopy) showed no residual leak and no stricture of the @entity254 , and both of @entity1 had a normal rectal function.
