Scientific paperFull-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications
Section snippets
Methods
We performed a retrospective review of patients in a single surgical group who underwent TEM from 1995 to 2002. The objective of this study was to evaluate primary endoscopic transrectal closure of a peritoneal defect created during TEM. Approval for this study was obtained from the Legacy Portland Hospital Institutional Review Board. Data on 35 patients were obtained from a prospective database and a detailed chart review. Sufficient data were obtained from a total of 34 patients who were
Results
Thirty-four patients were treated with TEM and were included in our study. Patients were divided into 2 groups: those with entrance to the peritoneum (n = 11) and those without (n = 23). Mean age, ASA classification, distance of lesion from the anal verge, and gender distribution are listed in Table 1. Operative time, length of stay, margins, and postoperative use of antibiotics are listed in Table 2. Ninety-one percent of patients with entrance to the peritoneum left the hospital in <24 hours,
Comments
TEM has been shown to be a safe and effective minimally invasive technique for the resection of neoplasms ranging situated 4 to 24 cm from the anal verge [8], [9], [22], [23]. Without the option of TEM, 79% of our patients would have required laparotomy, 38% for benign disease. The morbidity and mortality associated with laparotomy are well described. The limitations of traditional transanal excision are also well known and consist mainly of difficult access and poor visualization. TEM—a
Conclusion
Entry into the peritoneum during TEM is not associated with an increased incidence of either major or minor complications. Entry into the peritoneum during TEM excision does not mandate conversion to an open laparotomy, but the defect may be safely repaired endoscopically if the surgeon has adequate endoscopic suturing skills. Appropriate lesions likely to be above the peritoneal reflection and within reach of the endoscope (4 to 24 cm) should be preferentially considered for full-thickness TEM
References (28)
- et al.
Transanal endoscopic microsurgery for rectal cancer
Eur J Cancer
(2002) Transanal endoscopic microsurgerycurrent indications and techniques
J Gastrointest Surg
(2000)- et al.
Technique and results of transanal endoscopic microsurgery in early rectal cancer
Am J Surg
(1992) - et al.
Video endoscopic transanal-rectal tumor excision
Am J Surg
(1997) - et al.
A system for a transanal endoscopic rectum operation
Chirurg
(1984) - et al.
Transanal endoscopic microsurgery
Leber Magen Darm
(1985) - et al.
Is local excision adequate therapy for early rectal cancer?
Dis Colon Rectum
(2000) - et al.
Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer
Cancer
(1989) - et al.
Bladder and sexual dysfunction after mesorectal excision for rectal cancer
Br J Surg
(2000) Mesorectal excision for rectal cancer
Br J Surg
(1996)