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TAMIS-Flap Technique

Full-thickness Advancement Rectal Flap for High Perianal Fistulae Performed Through Transanal Minimally Invasive Surgery

Rottoli, Matteo MD, PhD; Di Simone, Massimo P. MD; Poggioli, Gilberto MD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2019 - Volume 29 - Issue 4 - p e53–e56
doi: 10.1097/SLE.0000000000000692
Online Articles: Technical Reports

The formation of an advancement rectal flap could be technically demanding in the presence of high perianal of rectovaginal fistula, and the outcomes could be frustrated by the inadequate view, bleeding and a poor exposure through the standard transanal approach. The application of the transanal minimally invasive surgery (TAMIS) to the advancement rectal flap procedure could overcome these difficulties. In the lithotomy position, a partial fistulectomy was performed and the internal opening was closed. A full-thickness flap was mobilized initially through the classic transanal approach. Subsequently, the TAMIS port was inserted and the mobilization of the flap was carried on proximally for as long as required. The laparoscopic visualization allowed a perfect view, a proper orientation of the flap and accurate hemostasis. The TAMIS-flap procedure seems a promising technique to perform a long advancement rectal flap to treat high perianal or rectovaginal fistulae (Video, Supplemental Digital Content 1,

Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant’Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy

The authors declare no conflicts of interest.

Reprints: Matteo Rottoli, MD, PhD, Surgery of the Alimentary Tract, Sant’Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy (e-mail:

Received April 18, 2019

Accepted May 13, 2019

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