Management of Low-Rectal Anastomotic Sinus With Transanal Minimally Invasive Septotomy

Rectal magnetic resonance imaging and computed tomography (CT) chest with positron emission tomography established a clinical stage of IIIc (T3N2bM0), and the patient received neoadjuvant chemoradiation. Anastomotic leaks can be defined by grade as presented by the International Study Group of Rectal Cancer. 1 Grade A leaks are subclinical and amenable to observation, while grade B and C obligate active intervention: image-guided percutaneous drain placement and therapeutic laparotomy, respectively. Several such devices have been described, including laparoscopic electrocautery shears, harmonic scalpel, and LigaSure. 3 The Enseal device, which has a lateral thermal energy spread comparable to the LigaSure Retractable L-hook (1.6 mm vs. 1.5 mm, respectively), has the additional benefit of an articulating tip which can be positioned to take down the common wall with relative ease.