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SPEAKER 1: MRI image, showing short segment rectal stricture with proximal stool burden. TEMS device was placed and secured. And blunt investigation of the stricture showed no residual lumen, making dilation impossible. Other surgical options, including low-anterior resection and coloanal pull-through had been discussed, with patient desiring minimally-invasive resection.

Careful hook electrocautery dissection of the stricture was begun posteriorly to protect GU structures. Continued electrocautery dissection of the rectal stricture. Full-thickness dissection of the rectal stricture, exposing the proximal bowel. Proximal stool burden exposed and removed.

Complete circumferential excision of the rectal stricture and irrigation of the dissection field. Passage of the colonoscope from the proximal diverting ostomy, demonstrating contiguous bowel. Mucosa of the proximal and distal rectal segments was re-approximated with running quilled suture.

The procedure was completed without apparent complication. And the patient was discharged home on the day of surgery. Three months following the procedure, a flexible sigmoidoscopy was performed, showing an intact anastamosis and the patient's colostomy was reversed.

Video

Transanal Minimally Invasive Surgery

Transanal minimally invasive surgery (TAMIS) is a new, minimally invasive approach to rectal surgery that is performed through one of the body’s natural orifices — the anus. It can be used for the removal of rectal tumors but also for other indications, including treatment of benign rectal strictures. In this video, Gabriel R. Chedister, M.D., a resident at the Medical University of South Carolina (MUSC), narrates endoscopic footage from a recent case at MUSC Health in which TAMIS was used to remove a benign rectal stricture that had necessitated a colostomy. The procedure was performed by Virgilio V. George, M.D., Section Head of Colorectal Surgery at MUSC Health, with the assistance of MUSC Health colorectal surgeon Pinckney J. Maxwell, M.D.,  and Chedister. The stricture had not been caused by radiation or intestinal bowel disease. Several months after TAMIS, the colostomy was successfully reversed.

Related Presenters

Virgilio George, M.D..

Virgilio George, M.D.

Virgilio V. George, M.D., joined the Department of Surgery as associate professor and head of the section of colon and rectal surgery in 2015. His primary academic and clinical focus is in the field of colorectal surgery including benign ...

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Pinckney Johnstone Maxwell, M.D..

Pinckney Johnstone Maxwell, M.D.

Dr. Pinckney Maxwell earned his medical degree here at the Medical University of South Carolina in Charleston, South Carolina. He completed his residency in general surgery at the Louisiana State University Health Sciences Center in New ...

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