gms | German Medical Science

Background: Transvaginal and transrectal natural orifice translumenal endoscopic sigmoidectomy for diverticular disease are offered as a standard procedure in our clinic. Feasibility of transrectal and transvaginal resection as well as perioperative morbidity were assessed in a consecutive series.

Materials and methods: All Patients undergoing elective sigmoidectomy for diverticular disease between october 2011 and september 2015 were prospectively entered in a study database. The primary endpoint was feasibility of a NOTES sigmoidectomy, either in transrectal or transvaginal technique. Secondary endpoints were morbidity, length of stay and inflammatory response. A medial-to-lateral dissection with full mobilization of the splenic was performed.

Results: Of 124 elective sigmoidectomies, 83% (n = 103) were enrolled for either transvaginal (n = 47) or transrectal NOTES resection (n = 56). There was no difference in body mass index or indication between patients undergoing laparoscopic-assisted, transvaginal, or transrectal sigmoidectomy, although transrectal resected patients were younger. The conversion rate from transrectal and transvaginal NOTES sigmoidectomy to a laparoscopic-assisted procedure with a minilaparotomy was 25% and 15%, respectively. All conversions were decided before attempted NOTES accesss and the main reason was a size mismatch of the specimen and extraction channel. Major morbidity was 10%, including 2 septic complications.

Conclusion: In elective laparoscopic sigmoidectomy for diverticular disease transvaginal and transrectal NOTES surgery is feasible and safe in the majority of patients. Acceptance of this technique among patients is very high. Transvaginal and transrectal NOTES sigmoidectomy should be offered for elective sigmoidectomy presupposing advanced laparoscopic experience.