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Peritoneal perforation during transanal endoscopic microsurgery is not associated with significant short-term

Jonathan Ramkumar1, Ahmer A Karimuddin1,2, P Terry Phang1,2

  • 1Division of General Surgery, University of British Columbia, Vancouver, Canada.

Surgical Endoscopy
|July 20, 2018
PubMed
Abstract

Insights

Transanal endoscopic microsurgery (TEM) peritoneal perforation occurs in 6% of patients. Proximal, anterior lesions increase risk, but outcomes are similar to patients without perforation, with safe management possible.

Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Surgical Outcomes

Background:

  • Transanal endoscopic microsurgery (TEM) is a surgical technique for rectal lesions.
  • Peritoneal cavity breach (TEM-P) is a known intraoperative complication.
  • Understanding predictors and outcomes of TEM-P is crucial for patient safety.

Purpose of the Study:

  • To analyze predictors of peritoneal perforation during TEM.
  • To compare short-term outcomes of patients with TEM-P versus those without (TEM-N).
  • To identify patient and tumor characteristics associated with peritoneal breach.

Main Methods:

  • Retrospective review of a prospectively maintained database of TEM patients (2007-2016).
  • Comparison of two groups: TEM-P (peritoneal perforation) and TEM-N (no peritoneal compromise).
  • Statistical analysis using t-tests and chi-squared tests.

Main Results:

  • 39 patients (6%) experienced TEM-P out of 619 total TEM procedures.
  • TEM-P was associated with more proximal (11 vs. 7 cm) and anterior (56% vs. 43%) lesions.
  • TEM-P patients had longer operations (80 vs. 51 min) and hospital stays (2 days), with fewer day surgeries (31% vs. 73%).

Conclusions:

  • Peritoneal breach during TEM can be safely managed with outcomes comparable to patients without perforation.
  • Proximal and anterior rectal lesions are identified as key predictors of peritoneal perforation during TEM.
  • The study highlights the feasibility of managing TEM-P without significant short-term morbidity.
Keywords:
AdenomaPeritoneal perforationRectal cancerTransanal endoscopic microsurgery

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