Anorectal functional outcome after repeated transanal endoscopic microsurgery

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Oncology

Background:

• Transanal endoscopic microsurgery (TEM) is used for rectal polyp resection.
• Repeated TEM may impact anorectal function.
• Assessing functional outcomes is crucial for patient quality of life.

Purpose of the Study:

• To evaluate anorectal function after multiple TEM procedures.
• To assess the impact of repeated TEM on internal and external anal sphincter integrity.
• To determine the long-term quality of life after repeated TEM.

Main Methods:

• Twenty-one patients with multiple rectal polyps underwent at least two TEM procedures.
• Anorectal manometry, endoanal ultrasonography, and quality of life questionnaires (SF-36) were used.
• Functional parameters were assessed preoperatively and at multiple time points post-surgery.

Main Results:

• Anal resting pressure and maximum tolerable volume significantly decreased at 3 months post-TEM but recovered by 6 months.
• Maximal squeeze pressure decreased initially but normalized by 3 months.
• Internal anal sphincter thickness decreased at 3 months but recovered by 6 months; external anal sphincter thickness remained stable.
• Rectoanal inhibitory reflexes were transiently affected but largely recovered by 6 months.
• Quality of life scores were comparable to the general population.

Conclusions:

• Anorectal function is generally preserved after repeated transanal endoscopic microsurgery.
• Multiple TEM procedures are a safe and effective option for managing extensive rectal polyposis.
• The functional recovery observed suggests TEM is a viable organ-preserving approach.