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Tricks to decrease the suture line dehiscence rate during endoluminal loco-regional resection (ELRR) by transanal

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Transanal Endoscopic Microsurgery (TEM) for early low rectal cancer offers good outcomes. A modified technique filling the residual cavity reduced suture line dehiscence risk, improving patient safety.

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Oncology

Background:

  • Transanal Endoscopic Microsurgery (TEM) is a viable alternative to Transanal Minimally Invasive Surgery (TME) for select early low rectal cancer patients.
  • TEM offers comparable oncological outcomes and improved Quality of Life compared to TME.
  • Standard TEM technique involves closing the residual defect, potentially increasing suture line dehiscence risk.

Purpose of the Study:

  • To evaluate a modified technique aimed at reducing suture line dehiscence after Extended Local Resection Rectum (ELRR) by TEM.
  • To assess the efficacy of filling the perirectal residual cavity and rectal ampulla stuffing in preventing complications.

Main Methods:

  • Retrospective analysis of 50 patients undergoing ELRR by TEM, divided into two groups (25 each).
  • Group A: Standard TEM technique with residual defect closure.
  • Group B: Modified technique involving filling the perirectal cavity with a hemostatic agent, rectal ampulla stuffing with gauzes, and transanal catheter for gas evacuation.

Main Results:

  • No significant differences in tumor characteristics, operative time, or pathological staging between groups.
  • Suture line dehiscence occurred in 3 patients (12%) in Group A, with no dehiscence in Group B (0%).
  • Patients experiencing dehiscence had larger lesions (mean 6.3 cm) and had not received neoadjuvant radio-chemotherapy.

Conclusions:

  • Suture line dehiscence after ELRR by TEM is likely associated with the size of the residual cavity.
  • Obliterating the perirectal space with hemostatic agents and rectal packing may decrease the risk of postoperative perirectal abscess.
  • The modified technique shows promise in reducing suture line dehiscence rates in ELRR by TEM.