AI Article Synopsis
- The study, conducted on 262 TEMS procedures over nine years, aimed to assess postoperative complications of rectal lesion excisions.
- Among patients with an average age of 72, complications occurred in 13% of cases, with pelvic sepsis and postoperative hemorrhage being significant concerns.
- The findings suggest that while TEMS is generally safe, patients with lesions close to the dentate line face higher risks, and utilizing ultrasonic dissection may reduce bleeding compared to diathermy.
Article Abstract
Background: The aim of this study was to determine the postoperative complications of Transanal Endoscopic Microsurgery (TEMS) excision of rectal lesions.
Method: A prospective audit of 262 consecutive TEMS procedures performed by a single surgeon between 1999 and 2008.
Results: The mean age of patients was 72 years. The mean area of the lesions excised was 17.5 cm(2) with a mean diameter of 4.5 cm at a mean distance of 7.4 cm from the dentate line. There were 201 full thickness excisions, 51 partial thickness excisions and nine were mixed or unclassified. Thirty-three (13%) patients developed 41 complications. There were two (0.8%) deaths within 30 days. Pelvic sepsis occurred in seven (3%) patients and was significantly more common after excision of low lesions within 2 cm of the dentate line. Postoperative haemorrhage occurred in seven (3%) patients and was significantly less common when dissection was performed with ultrasonic dissection than with diathermy. Fourteen (5%) patients developed acute urinary retention. Four (1.5%) patients developed rectal stenosis and four (1.5%) suffered uncomplicated surgical emphysema that required no treatment.
Conclusions: Transanal endoscopic microsurgery is a safe operation with a low mortality and morbidity. Pelvic sepsis is more common after excision of lesions within 2 cm of the dentate line. Ultrasonic dissection is associated with less postoperative haemorrhage than diathermy.
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| http://dx.doi.org/10.1111/j.1463-1318.2009.02071.x | DOI Listing |
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