LAUSR

Anastomotic stenosis, a major complication after low-anterior resection, can usually be treated by endoscopic balloon dilation [1, 2]. However, endoscopic management is challenging in the presence of a complete obstruction because an endoscope and other devices cannot be passed through the obstruction. Combined endoscopic incision and balloon dilation has reportedly been useful for treating complete rectal anastomotic obstruction [3]. If the patient has a stoma with double orifices, a simultaneous antegrade–retrograde approach to the obstructed anastomosis using two endoscopes may be feasible, a method known as the “rendezvous technique”[4]. A woman in her 60 s underwent laparoscopic rectal low-anterior resection and a diverting loop ileostomy after previous endoscopic submucosal dissection (ESD) for early rectal cancer. Stoma closure was scheduled to be performed 7 months post-surgery, but a colonoscopy performed for preoperative evaluation revealed complete obstruction of the rectal anastomosis (▶Fig. 1). Accordingly, endoscopic intervention was attempted for this obstruction. An endoscope (PCF-H290TI; Olympus Co., Tokyo, Japan) with a distal attachment (D-201-11804; Olympus) was passed through the distal loop ileostomy site until it reached the oral side of the obstruction site. Simultaneously, another endoscope (PCF-H290ZI; Olympus) with a distal attachment (D-20113404; Olympus) was inserted transanally. Although contrast agent sprayed through the trans-stomal endoscope did not flow to the anorectal side (▶Fig. 2), transillumination from the trans-stomal endoscope could be seen across the septum (▶Fig. 3), suggesting the obstruction was membranous. The obstruction site was incised from the anal E-Videos