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Transanal endoscopic microsurgery excision: is anorectal function compromised?

M L Kennedy1, D Z Lubowski, D W King

  • 1Colorectal Unit, St. George Hospital, Sydney, Australia.

Diseases of the Colon and Rectum
|May 11, 2002
PubMed
Summary
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Transanal endoscopic microsurgery reduces anal resting pressure but does not impact short-term continence. This rectal surgery technique requires further evaluation for its effects on anorectal function.

Area of Science:

  • Colorectal Surgery
  • Surgical Technology
  • Anorectal Physiology

Background:

  • Transanal endoscopic microsurgery (TEMS) is an emerging technique for rectal tumor excision.
  • The procedure involves prolonged anal sphincter dilation, raising concerns about anorectal function.

Purpose of the Study:

  • To evaluate the impact of transanal endoscopic microsurgery on anorectal function.
  • To assess changes in anal sphincter tone and patient continence post-surgery.

Main Methods:

  • Prospective evaluation of 13 patients undergoing TEMS for rectal tumors.
  • Preoperative and postoperative anorectal manometry, pudendal nerve motor terminal latency, electrosensitivity, balloon studies, and endoanal ultrasound.
  • Continence assessment using a numeric scale at 3 and 6 weeks post-surgery.

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Main Results:

  • A significant decrease in mean anal resting pressure was observed post-TEMS (P = 0.0009).
  • No significant changes were noted in squeeze pressure, cough pressure, nerve latency, electrosensitivity, or rectal balloon volumes.
  • The reduction in resting pressure correlated with operating time (r2 = 0.39, P = 0.047).
  • No significant change in mean continence score was found in the short term.

Conclusions:

  • Transanal endoscopic microsurgery leads to a reduction in internal anal sphincter tone.
  • This reduction in sphincter tone did not compromise short-term fecal continence in the studied patients.