Scientific paper
Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications

Presented at the 90th Annual Meeting for the North Pacific Surgical Association, Portland, Oregon, November 14–15, 2003
https://doi.org/10.1016/j.amjsurg.2004.01.004Get rights and content

Abstract

Purpose

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for full-thickness excision of benign and malignant rectal neoplasms located 4 to 24 cm above the anal verge. Entrance into the peritoneal cavity during TEM has been regarded as a complication that mandates conversion to open laparotomy for adequate repair of the defect. This study compares the rate of complications arising from TEM with and without intraperitoneal entry.

Methods

Patients undergoing peritoneal entry were compared to those who did not.

Results

No perioperative deaths occurred. There was no significant difference in the incidence of postoperative complications. No major complications occurred with peritoneal entry, and all peritoneal entries were closed transanally via endoscope.

Conclusions

Entry into the peritoneum during TEM is not associated with an increased incidence of complication. Entry into the peritoneum during TEM excision does not mandate conversion to open laparotomy but may be safely repaired endoscopically. Lesions likely to be above the peritoneal reflection and within reach of the endoscope (4 to 24 cm) should be considered for TEM excision.

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)

  • W.E Enker et al.

    Safety and efficacy of low anterior resection for rectal cancer681 consecutive cases from a specialty service

    Ann Surg

    (1999)
  • L.E Smith et al.

    Transanal endoscopic microsurgery. Initial registry results

    Dis Colon Rectum

    (1996)
  • T.J Saclarides et al.

    Transanal endoscopic microsurgery

    Dis Colon Rectum

    (1992)
  • W Lee et al.

    Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer

    Surg Endosc

    (2003)
  • Cited by (0)

    View full text