PP-001 Transanal endoscopic microsurgery: a useful technique but not without complication

• Published in: Gut Vol. 59; no. Suppl 1; p. A40
• Main Authors: Dalton, S J, Old, O J, Vaughan-Shaw, P G, Thomas, M G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2010
• Subjects: Cancer screening; Emphysema; Endoscopy; Fistulae; Intestine; Invasiveness; Medical screening; Microsurgery; Patients; Rectum; Sphincter; Stricture; Surgery; Ultrasound; Vagina
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2009.208991s

IntroductionTransanal endoscopic microsurgery (TEMS) is well established as a technique for the resection of rectal lesions and, with the advent of the Bowel Cancer Screening Programme its role is likely to increase. TEMS is less invasive than trans-abdominal surgery and causes less sphincter injury than a trans-anal approach however it is not without risk. In this retrospective cohort study we review the complications occurring with TEMS in our unit.MethodsAn electronic database was used to identify the outcomes of patients undergoing TEMS procedures; operation and anaesthetic notes and pathology reports were reviewed.Results100 patients were included, (59 male 41 female), mean age was 69. ASA grade I,15; II,60; III,23 and IV,2. All patients underwent preoperative assessment with endoanal ultrasound; in 80 patients TEMS was performed for benign disease and in 20 patients for carcinoma. In 18 cases the lesion was located in the lower rectum and in 82 in the mid or upper third. Resections were carried out in the submucosal plane in 33 patients and in 67 a full thickness resection was performed, full thickness defects were closed in all cases. Mean operating time was 110 min (95% CI 84 to 126) and median length of stay 3 days (range 1–31). 21 patients had complications; eight patients bled post operatively with two requiring re-exploration, two patients developed post operative emphysema, one patient sustained a caecal perforation requiring an emergency right hemicolectomy, one patient perforated a diverticulum, one developed a recto-vaginal fistula postoperatively and one sustained a bladder injury which was repaired intraoperatively. Two patients developed symptomatic strictures at the resection site, two had cardiac complications, one developed pneumonia, one went into retention and one developed a para-rectal abscess. Complications were associated with those patients undergoing a full thickness resection and with resections in the upper rectum.ConclusionTEMS remains a useful technique for the resection of rectal lesions however the potential complications associated with this technique should not be underplayed. Here we describe the complications associated with TEMS in our unit.