Our Summary

This research paper discusses a study on a surgical procedure called transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS), which is a method for removing a part of the colon (specifically, the sigmoid colon). This procedure is used to treat patients with diverticular disease, a condition where bulging pockets develop in the digestive system, typically in the colon.

In the study, patients scheduled for this procedure were followed and their outcomes were recorded. The researchers were interested in whether the procedure could be performed successfully, complications that occurred, the level of pain experienced by the patients, their recovery time, and their body’s inflammatory response to the surgery.

The procedure was performed using a method where the colon is manipulated and detached from inside the body and then removed through the rectum. To protect the rectum during this extraction, a wound protector was used.

Out of 95 patients who were due for a colon removal surgery, 77 were enrolled for either a transvaginal NOTES resection or the trNS procedure. There was no significant difference in the body mass index of the patients or the reason they needed the surgery, although those receiving the trNS procedure were generally younger. Occasionally, the trNS procedure had to be switched to a different method due to a mismatch between the size of the removed colon part and the narrowness of the pelvis. About 10% of the patients experienced significant complications, including two who developed septic complications.

The researchers concluded that the trNS procedure is feasible and safe for a large proportion of patients with diverticular disease. They recommend using a certain technique for reattaching the remaining parts of the colon, and suggest that the trNS procedure should be considered for elective sigmoidectomy, but only by surgeons with advanced laparoscopic experience.

FAQs

  1. What is the primary goal of evaluating the feasibility of transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS)?
  2. What were the results of the study on the feasibility of transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy (trNS)?
  3. What is the preferred technique for anastomosis in transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy (trNS)?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to make sure to follow post-operative care instructions carefully, including proper wound care, pain management, and diet restrictions. It is also important to attend all follow-up appointments with your healthcare provider to monitor your recovery progress.

Suitable For

Patients with diverticular disease who are undergoing elective sigmoidectomy can be recommended for transrectal rigid hybrid natural orifice translumenal endoscopic surgery (trNS). This procedure offers reduced pain and easier recovery compared to traditional laparoscopic surgery. Patients with a bulky specimen and narrow pelvis may require conversion to laparoscopic-assisted sigmoidectomy (LAS). Overall, trNS is considered feasible and safe for a high proportion of patients with diverticular disease, especially those with advanced laparoscopic experience.

Timeline

Before sigmoidectomy:

  • Patient is diagnosed with diverticular disease and scheduled for elective sigmoidectomy
  • Patient is enrolled in a prospective registry on an intention-to-treat basis
  • Patient undergoes transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS)
  • Procedure includes medial-to-lateral dissection, full mobilization of the splenic flexure, and total intracorporeal anastomosis
  • Rectum is covered with a wound protector for transrectal extraction

After sigmoidectomy:

  • 81% of patients were enrolled in the study for trNS
  • 17.5% of trNS cases were converted to laparoscopic-assisted sigmoidectomy (LAS) due to bulky specimen and narrow pelvis
  • Major morbidity rate was 10%, including 2 septic complications
  • Anastomosis technique was changed from double stapled end-to-end to side-to-end anastomosis
  • trNS is considered feasible and safe for elective sigmoidectomy in patients with diverticular disease, especially for those with advanced laparoscopic experience.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with sigmoidectomy surgery?
  2. How long is the recovery period after sigmoidectomy surgery?
  3. What is the success rate of transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy?
  4. How experienced is the surgical team in performing transrectal sigmoidectomy procedures?
  5. What alternative treatment options are available for diverticular disease?
  6. Will I require a temporary or permanent colostomy after sigmoidectomy surgery?
  7. How will my pain be managed after the surgery?
  8. What dietary changes or restrictions will I need to follow after sigmoidectomy surgery?
  9. How often will I need follow-up appointments after the surgery?
  10. Are there any long-term effects or considerations I should be aware of after having a sigmoidectomy?

Reference

Authors: Lamm SH, Zerz A, Efeoglou A, Steinemann DC. Journal: J Am Coll Surg. 2015 Oct;221(4):789-97. doi: 10.1016/j.jamcollsurg.2015.07.012. Epub 2015 Jul 21. PMID: 26282488