Transanal ileoproctostomy in a human cadaver

Objective of the study: The technical feasibility of ileorectal by-pass (ileoproctostomy), performed entirely through a transanal access, was previously evaluated and demonstrated in a porcine model. The aim of this study was to verify the technical feasibility of the same operation in a human cadaver.

Methods and procedures: The procedure was carried out in a human male cadaver. A Transanal Endoscopic Microsurgery (TEM) device and endoscopic instruments were utilized.

Results: The study demonstrates that ileorectal bypass through a transanal access is technically feasible in humans. The principal steps of the procedure are:

• TEM device placement;

• rectal perforation above the peritoneal reflection;

• peritoneoscopy using a standard gastroscope;

• grasping the small bowel with retrieval forceps and pulling it through the rectal hole;

• suturing the ileum and the rectum together through the TEM device

• opening the ileal loop followed by endoscopic exploration

Conclusions based on the results: Ileorectal bypass through a transanal access is technically feasible in humans and although still at an experimental stage, it could become a surgical option in the treatment of some types of colonic strictures.