taTME in patients undergoing laparoscopic restorative proctocoloctomy for familial adenomatous polyposis

Background:

Transanal total mesorectal excision (taTME) is a minimally invasive technique which was developed to overcome the difficulties associated with the „top-down“ pelvic dissection by enabling a „bottom-up „ approach in patients with mid and low rectal cancer. While this technique was primarily designed to manage malignant tumors in the mid and lower rectum, its spectrum of indications has been broadened to include benign colorectal pathologies. Additionally, it is our preference as in all of these patients not to construct a deviation, but to fashion a virtual ileostomy as reported previously. In this small series, only one patient required secondary deviation due to anastomotic leakage on day 9. Herein, we report our initial experience with taTME in patients undergoing restorative proctocoloctomy for familial adenomatous polyposis (FAP).

Methods:

The results of fifteen consecutive patients (nine females and six males) undergoing prophylactic restorative proctocolectomy with IPAA for FAP using taTME are presented.

Results:

The median age in this series was 19.5yrs (range: 16 – 31yrs). Surgery was successfully completed using the taTME approach in all cases. No perioperative complications were recorded. A median of five bowel movements with intermittent anti-diarrheal medication in average was recorded in all cases at an early postoperative follow-up of 5 – 24 months.

Conclusion:

Our initial experience on fifteen consecutive cases suggests taTME to be safe and effective in patients undergoing prophylactic restorative proctocolectomy with IPAA for FAP. Interestingly, at an early postoperative follow-up patients have a lower than usual frequency of bowel movements at an early postoperative stage. Further prospective evaluation of this strategy is mandatory, since early postoperative results suggest an excellent functional outcome.