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A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery
J A Gracia Solanas1, J M Ramírez Rodríguez, V Aguilella Diago
1Section of Coloproctology, Department of Surgery 'B'. Hospital Clínico Universitario, Zargoza, Spain. josegraciasolanas@hotmail.com
Revista Espanola De Enfermedades Digestivas
|June 24, 2006
Summary
Transanal endoscopic microsurgery (TEM) can cause temporary incontinence due to internal anal sphincter rupture, leading to decreased anal pressures. However, functional results often recover within six months.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Anorectal Physiology
Background:
- Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for rectal adenomas and early adenocarcinomas.
- While TEM shows excellent outcomes in morbidity and recurrence, functional results require further investigation.
Purpose of the Study:
- To analyze the impact of TEM on anal anatomy.
- To compare manometric results before and after TEM.
Main Methods:
- A prospective study included 40 patients undergoing TEM.
- Incontinence questionnaires, endoanal ultrasonography, and manometry were performed preoperatively and postoperatively.
Main Results:
- Internal anal sphincter (IAS) rupture occurred in 3 patients (7.5%), with external anal sphincter integrity maintained.
- Mean anal resting pressure (ARP) decreased from 87.2 to 70.1 mmHg, and maximal squeeze pressure (MSP) decreased from 152.5 to 142.2 mmHg at 3 months.
- Three patients experienced temporary flatus incontinence, resolving by 6 months.
Conclusions:
- TEM involves significant anal dilatation, potentially causing IAS rupture and decreased anal pressures.
- While sphincter integrity influences outcomes, IAS rupture can lead to temporary incontinence, with functional recovery observed.