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AIM: In this technical note we describe a simplified totally transabdominal technique to perform a single stapled end-to-end colorectal anastomosis without the need for transanal transection, linear stapler line resection, purse string or dog-ear suturing. METHOD: The rationale and the technique itself are first explained by using a schematic design. Next, step-by-step pictures of one of our cases show the feasibility and advantages of this technique. At the end, the limits of this technique are illustrated. RESULTS: The technique was used for 20 colorectal anastomosis, 9 benign and 11 oncological cases. Median age was 68 years and average BMI was 28 kg/m2. Risk factors for anastomotic leakage were reported in 10 cases. The bow tie technique was performed in every case and the linear stapler line was entirely resected in all cases. No positive air leak test or anastomotic leakage was reported. CONCLUSIONS: The bow tie technique is a feasible technique to perform an end-to-end single stapled colorectal anastomosis with promising results on anastomotic leakage. Further research with larger prospective data collection is necessary to validate this technique and show its potential benefit on anastomotic leakage.
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INTRODUCTION: Multinodular goiter associated with preoperative vocal cord palsy is usually indicative of invasive thyroid malignancy. However, benign thyroid disease may also lead to vocal cord paralysis. CASE REPORT: We present a case of a 63-year old woman with a two-month history of hoarseness, loss of vocal pitch, difficulties with swallowing and shortness of breath. Preoperative flexible fiberoptic laryngoscopy showed a left vocal cord paralysis. Left hemithyroidectomy with isthmectomy under intraoperative neuromonitoring for multinodular goiter was performed. Intra-operatively, both ipsilateral recurrent laryngeal nerve (RLN) and vagal nerve (VN) were identified and preserved. Follow-up laryngoscopy 5 weeks postoperatively showed complete recovery of the left vocal cord movement. DISCUSSION: Intuitively, surgeons may assume that preservation of a palsied RLN in patients with preexisting vocal cord paralysis is not meaningful. However, patients with RLN palsy associated with benign thyroid disease can experience full recovery after surgery. CONCLUSION: Multinodular goiter associated with preoperative vocal cord paralysis should be managed with extreme caution and use of intra-operative neuromonitoring. The existing probability of intra-operative recovery of a preoperative RLN palsy underlines the importance of preserving the affected RLN during surgery for benign thyroid disease.