Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach

• Published in: International Brazilian Journal of Urology Vol. 41; no. 5; pp. 1020 - 1026
• Main Authors: Tobias-Machado, Marcos, Mattos, Pablo Aloisio Lima, Reis, Leonardo Oliveira, Juliano, César Augusto Braz, Pompeo, Antonio Carlos Lima
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Urologia 01.10.2015
• Subjects: Aged; Anal Canal - surgery; Challenging Clinical Cases; Fistula; Humans; Male; Medical Illustration; Natural Orifice Endoscopic Surgery; Operative Time; Postoperative Complications; Postoperative Complications - surgery; Prostatectomy - adverse effects; Rectal Fistula - etiology; Rectal Fistula - surgery; Reproducibility of Results; Transanal Endoscopic Surgery - instrumentation; Transanal Endoscopic Surgery - methods; Treatment Outcome; Urinary Bladder Fistula - etiology; Urinary Bladder Fistula - surgery
• ISSN: 1677-5538; 1677-6119; 1677-6119; 1677-5538
• DOI: 10.1590/S1677-5538.IBJU.2014.0002

Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.