Long-Term Anorectal Manometry Outcomes After Laparoscopic and Transanal Total Mesorectal Excision

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Transanal total mesorectal excision (TaTME) involves anal canal dilation, potentially damaging the sphincter complex.
• Laparoscopic total mesorectal excision (LaTME) is an alternative approach for rectal cancer surgery.
• Assessing and comparing the impact of these techniques on anorectal function is crucial.

Purpose of the Study:

• To analyze and compare the impact of laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (TaTME) on anorectal sphincter function.
• To evaluate changes in manometric pressure and low anterior resection syndrome (LARS) scores post-surgery.

Main Methods:

• An observational study comparing two matched cohorts undergoing LaTME or TaTME for rectal cancer.
• Anorectal function assessed by manometry pre- and post-surgery (≥6 months).
• Intestinal function evaluated using the low anterior resection syndrome (LARS) score.

Main Results:

• A decrease in mean resting and squeeze pressures was noted in both groups, with significant reduction in squeeze pressure for both TaTME (P=.003) and LaTME (P=.004).
• Postoperative squeeze pressure reduction correlated with worsening LARS scores (rho 0.587; P=.004).
• Time since surgery negatively correlated with LARS scores (rho -0.696; P=.001) and pressure changes (rho -0.499; P=.018).

Conclusions:

• Manometric findings after total mesorectal excision (TME) are comparable between laparoscopic and transanal approaches.
• Deterioration in anal sphincter function and LARS scores improves over time after surgery.
• Both LaTME and TaTME require careful consideration of potential sphincter dysfunction and long-term functional recovery.