Endoscopic "rendez-vous" technique in colorectal surgery. step-by-step: A new treatment for acute stenosis after anastomotic dehiscence- Video-Vignette.

Anastomotic leakage remains to be one of the most serious complications of colorectal surgery having a greater incidence in low-lying anastomosis. Furthermore, anastomotic stricture is also another threatening complication that encompasses a variety of clinical manifestations that may lead to a permanent stoma. We present a 43-year-old patient with a rectal tumour located at 3cm from the anal verge (T4N1M0). After neoadjuvant chemoradiotherapy, the patient underwent TaTME surgery with a coloanal anastomosis and a protective ileostomy, achieving R0 resection. During follow-up, partial coloanal anastomotic dehiscence with a presacral cavity was diagnosed starting 2cm and ending 15cm from the anal verge. The anastomotic dehiscence was treated with endoscopic vacuum sponge therapy. However, a 2mm diameter anastomotic stricture was revealed at the proximal end of the anastomosis that did not allow the passage of the endoscope. Therefore, a combined endoscopic "Rendez-vous" technique was performed in order to gain access across the anastomosis and to place a temporary fully covered self-expandable metallic biliary prothesis. After a one-month follow-up, the removal of the stent was carried out successfully. Currently and prior to ileostomy closure, stimulation of the efferent limb is being performed with a good response. This technique enables bowel reconstruction and avoids a permanent stoma improving the patient's quality of life. There is limited data available for the use of covered stents and the Rendez-vous approach for anastomotic strictures or leaks. The endoscopic "Rendez-vous" technique could be a new feasible and effective procedure for challenging coloanal anastomotic complications.