Hospital Clínic of Barcelona Performs First-Ever Total Removal of Colon Through Anus

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  • The operation was held in Barcelona by Dr. Antonio Ma de Lacy, Head of the Gastrointestinal Surgery Unit at the Hospital Clínic (University of Barcelona), through a new surgical technique, HANDS.
  • This procedure could be applied in 100% of patients who need a colon removal.
  • The patient, 36 years old and diagnosed with severe ulcerative colitis, was discharged a few days after surgery.
  • The technique avoids abdominal incisions, reduces pain and allows quicker and better recovery.

Barcelona— It is the simplest form of surgery. It is called MANOS (Assisted Natural Orifice Surgery Microlaparoscopy) and represents the evolution of the technique NOTES (Natural Orifice Transluminal Endoscopy Surgery), the surgical approach that allows an operation through the body’s natural openings, used to remove tumors or organs through vagina, mouth or anus. Dr. Antonio M a de Lacy, Head of Gastrointestinal Surgery Unit at the Hospital Clínic of Barcelona, a pioneer in developing minimally invasive surgical techniques, has made, for the first time ever, the complete removal of the colon through the anus, using a hybrid technique that combines laparoscopy and endoscopy, and avoids the infectious complications related to the transanal route. Results will be published in the journal Surgical Endoscopy. On July 13, the team of surgeons, anesthesiologists and nurses from the Catalan hospital, led by Dr. de Lacy, in collaboration with Dr. Graciela Martinez and Dr. Raquel Bravo, from the Reanimation and Anesthesiology Service and the Digestive Surgery Service respectively, operated on a 36-year-old man diagnosed with severe ulcerative colitis, a disease which affects around 70,000 people in Spain, with 6,000 to 8,000 new cases every year. It is the first time in the world that a total colectomy (removal of the entire colon) is made in the treatment of inflammatory disease of the large intestine, a severe disease causing abdominal pain, frequent diarrhea and the appearance of blood and mucus in the stool. Ulcerative colitis is in a group of so-called inflammatory bowel diseases, such as Crohn’s disease. These are chronic diseases            with recurrent manifestations. Unlike Crohn’s disease, which affects the entire digestive tract (from mouth to anus), ulcerative colitis affects only the colon, especially in the most distal (rectum). In this case, the failure of immunosuppressive drug therapy (the cause is unknown, but numerous hypotheses suggest the autoimmune origin of ulcerative colitis), motivated the surgery for total removal of the affected organ. “When the surgery is justified by the immunosuppressive treatment-resistant disease, total colectomy and subsequent reconstruction of the organ are presented as the only solution,” said Dr. de Lacy. This patient was the perfect candidate for less invasive surgery because of its gravity box marked by malnutrition, anemia or frequent intake of steroid drugs. During the operation all surgical instruments were introduced through the anus to prevent painful abdominal incisions. This new technique has been developed to achieve better results than laparoscopic surgery, and even better than NOTES surgery. Minimally invasive techniques guarantee many advantages: reduced pain, shorter hospital stay and better oncologic results. MANOS technique was performed through three laparoscopic ports in the abdomen, 12, 3 and 5mm for each one. The larger diameter was used for subsequent ileostomy (opening in the abdominal wall during surgery to take waste out of the body when the colon or rectum do not work properly). The surgery has gone a step further and now allows successful operation on  chronic inflammatory diseases without scarring, unlike the aforementioned laparoscopy, which reduces scars to four or five minimal incisions. “The procedure was done because it was seen as the only possible solution,” said Dr. de Lacy. Never before has this  operation through the rectum been performed, but the Clinic team has proven that it is safe and has extrapolated the result to future cases. “The result, after four hours of intervention, has been successful and confirmed the new technique as a reliable MANOS surgical tool,” he concludes.

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