Robotic high anterior resection for rectal cancer with hand-sewn Gambee anastomosis after metal stent placement in a colorectal malignant stricture: A case report

TL;DR

This case report describes the successful use of robotic surgery and Gambee anastomosis for rectal cancer after stent placement in a patient with a colorectal stricture.

Contribution

Demonstrates the effectiveness of Gambee anastomosis in robotic rectal resection after stent placement for malignant stricture.

Findings

Gambee anastomosis is a valid option for rectosigmoid junction stricture.

Suture failure can occur in swollen and obstructed intestinal tracts.

Anastomosis method should be chosen based on the organ's condition and location.

Abstract

Robot-assisted surgery is increasingly deployed in colorectal surgery, and decompression surgery using a stent is considered a standard treatment for malignant stenosis of the large intestine. Surgery after stent placement is also frequently performed. However, the anastomosis method remains controversial.

A 75-year-old woman visited our hospital's internal medicine department with chief complaints of bloody stool and constipation for the past year and colonoscopy was scheduled. After taking laxatives to prepare for treatment, abdominal pain was noticed and an emergency request was made. A diagnosis of colorectal malignant stricture and rectosigmoid junction cancer was made and a stent was placed during emergency colonoscopy. After intestinal decompression, a diagnosis of rectosigmoid junction cancer (UICC 8th; T3N0M0 Stage IIa) was rendered and robotic-assisted high anterior resection of the rectum and lymph node D3 dissection were performed. Reconstruction was performed using Gambee anastomosis outside the body cavity. The postoperative course was uneventful.

The double stapling technique is simple, but in this case, the obstructed intestinal tract was swollen. Meanwhile, Gambee anastomosis, which allows adjustment of tightness, was considered effective.

Gambee anastomosis is a valid option when robot-assisted rectal resection is performed after intestinal decompression with stent placement for malignant stricture of the rectosigmoid junction. It is important to select a hand-sewn or mechanical anastomosis by considering the condition of the organ to be anastomosed and the site of the anastomosis.

•Gambee anastomosis is a valid option for rectosigmoid junction stricture.•Suture failure can occur in swollen and obstructed intestinal tracts.•The hand-sewn or mechanical anastomosis should match the condition of the organ.

Gambee anastomosis is a valid option for rectosigmoid junction stricture.

Suture failure can occur in swollen and obstructed intestinal tracts.

The hand-sewn or mechanical anastomosis should match the condition of the organ.

Figures