腹腔镜与经肛腔镜辅助双镜联合代直肠切除吻合口重建术的疗效与安全性：单中心51例报告

背景与目的：代直肠切除吻合口重建手术可成功恢复多数直肠吻合失败及肿瘤局部复发患者的肠道连续性，避免患者永久性肠造口。然而该手术难度大、手术相关并发症发生率高。手术方式及入路的选择在降低手术难度、确保手术安全性及降低术后并发症方面具有重要意义。因此，本研究总结单中心8年间行腹腔镜与经肛腔镜辅助双镜联合代直肠切除吻合重建的手术经验，以期为临床提供循证参考。方法：回顾性收集中山大学附属第六医院结直肠外科2015年10月—2023年8月51例行代直肠切除吻合重建患者的病历资料。其中，24例行经肛腔镜辅助双镜联合代直肠切除吻合口重建术(双镜联合组)，27例行腹腔镜代直肠切除吻合重建术(腹腔镜组)。分析全组患者的术中、术后情况，并比较双镜联合组与腹腔镜组相关临床指标的差异。结果：51例患者均顺利完成代直肠切除吻合口重建手术。消化道重建吻合方式包括Bacon手术30例、Dixon手术5例、Parks手术15例、括约肌间切除术1例。51例患者中，拖出切除二期结肠肛管吻合30例、拖出切除单吻合5例、拖出切除双吻合3例、一期手工吻合13例。其中，术前已有肠造口患者42例、术后行新增预防性肠造口6例、术后未...

Efficacy and safety of laparoscopic versus transanal endoscopic-assisted dual-scope combination redo coloanal anastomosis: a single-center report of 51 cases

Background and Aims Redo coloanal anastomosis after rectal resection can restore intestinal continuity in most patients with rectal anastomotic failure or local tumor recurrence, avoiding permanent enterostomy. However, this surgery is challenging and associated with a high incidence of surgical complications. The choice of surgical approach is crucial for reducing the difficulty of the procedure, ensuring surgical safety, and reducing postoperative complications. Therefore, this study summarized the experience of performing laparoscopic and transanal endoscopic-assisted dual-scope combination redo coloanal anastomosis over 8 years at a single center to provide an evidence-based reference for clinical practice.Methods The clinical data of 51 patients undergoing redo coloanal anastomosis in Division of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University between October 2015 and August 2023 were retrospectively collected. Among them, 24 cases underwent transanal endoscopic-assisted dual-scope combination redo coloanal anastomosis (the dual-scope combination group), and 27 cases underwent laparoscopic r redo coloanal anastomosis (the laparoscopic group). Intraoperative and postoperative conditions of all patients were analyzed, and differences in relevant clinical variables between the dual-scope combination group and the laparoscopic group were compared.Results All 51 patients successfully underwent redo coloanal anastomosis. Methods of digestive tract reconstruction included Bacon operation in 30 cases, Dixon operation in 5 cases, Parks operation in 15 cases, and intersphincteric resection in 1 case. Among the 51 patients, 30 underwent pull-through resection with two-stage coloanal anastomosis, 5 underwent pull-through resection with single anastomosis, 3 underwent pull-through resection with double anastomosis, and 13 underwent one-stage manual anastomosis. Among them, 42 patients had an enterostomy before surgery, 6 underwent prophylactic enterostomy after surgery, and 3 did not undergo prophylactic enterostomy after surgery. The total operative time for the entire group was 296 (251-349) min, and the intraoperative blood loss was 100 (50-200) mL. There was no statistical difference in the operative time and intraoperative blood loss between the dual-scope combination and laparoscopic groups (both P>0.05). A total of 24 specimens were obtained transanally during the operation, with 5 in the laparoscopic group and 19 in the dual-scope combination group, showing a statistically significant difference (P<0.05). The postoperative hospital stay for the entire group was 17 (11-23.5) d. There was no statistical difference in the postoperative hospital stay between the dual-scope combination and laparoscopic groups ( both P>0.05). However, the time to postoperative gas passage and oral intake in the dual-scope combination group was shorter than in the laparoscopic group (both P<0.05). There were no patients in the entire group who were transferred to the ICU for treatment after surgery or died during hospitalization. Pathological examination of specimens from 9 patients with local tumor recurrence after surgery showed no tumor at the specimen margin. Sixteen patients in the entire group experienced complications (9 cases of Clavien-Dindo grade Ⅱ and 7 cases of grade Ⅲ or above), including 4 cases in the dual-scope combination group (16.67%) and 12 cases in the laparoscopic group (44.44%), with a statistically significant difference (χ²=4.554, P=0.033).Conclusion The choice of surgical approach and method for redo coloanal anastomosis should be based on the type of initial anastomotic failure, the distance of the lesion from the anus, the patient''s overall condition, and the level of medical care in the hospital to develop individualized treatment plans. Compared with simple laparoscopic redo coloanal anastomosis, transanal endoscopic-assisted dual-scope combination redo coloanal anastomosis has the advantages of faster postoperative recovery and a lower incidence of postoperative complications. Moreover, further follow-up is needed to evaluate the differences in enterostomy reversal rate, long-term anal function, and quality of life after redo coloanal anastomosis by the two surgical methods.