Fecal incontinence after transanal endoscopic microsurgery

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure for rectal lesions.
• The long-term effects of TEM on fecal continence are not fully understood.
• Assessing functional outcomes post-TEM is crucial for patient management.

Purpose of the Study:

• To evaluate the long-term functional outcomes of transanal endoscopic microsurgery (TEM).
• To identify risk factors associated with the development of fecal incontinence after TEM.
• To determine the impact of fecal incontinence on quality of life following TEM.

Main Methods:

• A prospective database of TEM patients was utilized.
• A postal questionnaire including the Wexner fecal incontinence grading scale and EQ-5D-5L was administered.
• Patients were categorized into groups based on fecal incontinence severity (Wexner score ≤2 vs. ≥3).

Main Results:

• 132 patients with a median follow-up of 96 months were analyzed.
• 28.8% of patients reported non-minor fecal incontinence (Wexner score ≥3), experiencing significantly worse quality of life.
• Older age at operation, longer operative time, and surgery for malignant lesions were associated with incontinence; older age was an independent risk factor.

Conclusions:

• Fecal incontinence is a prevalent complication after TEM, negatively affecting quality of life.
• Older age at the time of transanal endoscopic microsurgery is an independent predictor of significant fecal incontinence.
• Further research into mitigating fecal incontinence post-TEM is warranted.