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Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term
Justine A Gavagan1, Mark H Whiteford, Lee L Swanstrom
1Department of Minimally Invasive Surgery, Legacy Health System, 1040 NW 22nd Ave., Suite 560, Portland, OR 97210, USA.
American Journal of Surgery
|May 12, 2004
Summary
Transanal endoscopic microsurgery (TEM) involving peritoneal entry is safe and does not increase complications. This minimally invasive technique for rectal neoplasms can be repaired endoscopically, avoiding open surgery.
Area of Science:
- Colorectal surgery
- Minimally invasive surgical techniques
- Gastroenterology
Background:
- Transanal endoscopic microsurgery (TEM) is a minimally invasive approach for rectal neoplasm excision.
- Peritoneal entry during TEM has traditionally been considered a complication requiring conversion to open laparotomy.
Purpose of the Study:
- To compare complication rates in Transanal endoscopic microsurgery (TEM) with and without intraperitoneal entry.
- To evaluate the safety and necessity of converting to open laparotomy following peritoneal entry during TEM.
Main Methods:
- A comparative study design was employed.
- Patients undergoing TEM with peritoneal entry were compared to those without peritoneal entry.
Main Results:
- No perioperative deaths were recorded in either group.
- There was no statistically significant difference in the incidence of postoperative complications between the groups.
- All instances of peritoneal entry were successfully managed with transanal endoscopic repair, with no major complications reported.
Conclusions:
- Peritoneal entry during TEM for rectal neoplasms is not associated with an increased risk of complications.
- Endoscopic repair of peritoneal defects during TEM is a safe and effective alternative to open laparotomy.
- TEM is a viable option for lesions located 4 to 24 cm above the anal verge, even with potential peritoneal entry.