Rektovaginalinės fistulės plastika m. gracilis po chemospindulinio gydymo ir totalios mezorektinės ekscizijos dėl tiesiosios žarnos vėžio

Įvadas / tikslasRektovaginalinė fistulė (RVF) yra viena iš sunkiausiai gydomų komplikacijų po chemospindulinio gydymo ir totalios mezorektinės ekscizijos (TME) dėl tiesiosios žarnos vėžio. Manoma, kad šios komplikacijos tikimybė didesnė tiems ligoniams, kuriemsbuvo taikyta spindulinė terapija ir pooperaciniu laikotarpiu buvo išsivystęs sepsis. Ši komplikacija buvo gydoma atliekant musculus gracilis transpoziciją.Ligoniai ir metodaiRetrospektyviai buvo išanalizuoti 5 pacientai, kuriems nuo 2005 m. lapkričio 1 d. iki 2013 m. lapkričio 30 d. Vilniaus universiteto Onkologijos institute atliktos m. gracilis transpozicijos dėl rektovaginalinės fistulės.RezultataiBuvo atliktos penkios m. gracilis transpozicijos. Ligonių amžius – 57,2±17 metų. Ligonėms RVF išsivystė po taikyto chemospindulinio gydymo (50 Gy ir dviejų ciklų 5-FU + leukovorinas) ir TME, po kurios suformuota prevencinė ileostoma dėl tiesiosiosžarnos vėžio. Rektovaginalinė fistulė susiformavo per tris savaites po operacijos. Graciloplastikoms naudotas dešinės šlaunies m. gracilis. Sėkmingu gydymu laikyta užgijusi fistulė po ileostomos likvidavimo ir (arba) patvirtintas jos užgijimasproktoskopija, proktograma, oro–vandens ir metileno mėlio mėginiais. Mūsų centre operacijos sėkmė buvo 60 procentų.IšvadosMūsų duomenys patvirtina, kad graciloplastika yra naudinga rektovaginalinių fistulių gydymo metodika, juolab kad sėkmingų būdų šiai patologijai gydyti nėra daug.Reikšminiai žodžiai: chemospindulinis gydymas, graciloplastika, tiesiosios žarnos vėžys, rektovaginalinė fistulė, totali mezorektinė ekscizijaGraciloplasty of the rectovaginal fistula after chemoradiation followed by total mesorectal excision for rectal cancer: a single centre experiencePaulius Misenko, Narimantas Evaldas Samalavičius, Edgaras Smolskas Background / objectiveRectovaginal fistula (RVF) is one of the intractable complications following chemoradiation and total mesorectal excision (TME) for rectal cancer. It is supposed that there is a strong possibility of this complication in patients after radiation therapy and having an underlying sepsis. This complication was managed by gracilis muscle transposition.MethodsA retrospectively maintained database was used to identify patients who underwent gracilis muscle transposition for rectovaginal fistula at the Institute of Oncology, Vilnius University from November 2005 to November 2013.ResultsFive gracilis muscle transposition were perfomed. Patients mean age was 57.2±17 years. All patients were female. They received neoadjuvant chemoradiation with a total dose of 50 Gy and two cycles of 5-FU + leucovorin and TME with a colonic J-pouch anal stapled anastomosis, and preventive loop ileostomy. All of them developed RVF during three weeks postoperatively. Graciloplasty was performed using the gracilis muscle from the right thigh. The median length of hospital stay was 10 days (9–13). Success was defined as a healed fistula after ileostomy closure, and/or was confirmed by proctoscopy, proctography, negative air–water and methylene blue tests prior to that. In our center, the success rate is 60 percent.ConclusionsOur data confirm that the strategy of gracilis muscle transposition is a useful option for RVF management in such patients as the number of other successful modalities are limited.Key words: chemoradiation, graciloplasty, rectal cancer, rectovaginal fistula, total mesorectal excisio

Transkateterinė arterinė embolizacija gydant skrandžio ir dvylikapirštės žarnos opas

Background and objectiveTranscatheter arterial embolization is an alternative to surgical management when dealing with recurrent bleeding from a peptic ulcer after a failed endoscopic treatment. The purpose of this study is to analize the ffectiveness and outcomes of transcatheter arterial embolization and identify the factors that influenced morbidity and mortality rates.Materials and methodsA retrospective single-center analysis was performed of 20 patients who underwent transcatheter arterial embolization for acute upper astrointestinal bleeding from gastroduodenal ulcers from 2012 to 2015 at the Republic Vilnius University Hospital. We analyzed the association of early rebleeding and mortality with sex, age, number of units of blood components administered to the patients, length of hospital stay, time passed until embolization, therapeutic or prophylactic embolization.ResultsThe embolization procedure had a technical success rate of a 100%. 14 (70%) were prophylactic embolizations and 6 (30%) were therapeutic embolizations. Three patients (15%) had an episode of rebleeding following embolization, 5 (25%) patients died. Patients that died received statistically significant larger number of blood components (p=0.04 for frozen plasma;p=0.01 for packed red blood cells) and patients that survived had a shorter hospital stay (p=0.05). No associations were observed between rebleeding and factors analyzed.ConclusionsTranscatheter arterial embolization is a feasible method for the treatment of rebleeding in gastroduodenal ulcer after endoscopic treatment, resulting in high rates of technical and clinical success and low complication rates. Further prospective randomized trials are needed to obtain more evidence.ĮvadasTranskateterinė arterinė embolizacija yra chirurginio gydymo alternatyva. Ji taikoma esant pakartotiniam kraujavimui iš skrandžio ar dvylikapirštės žarnos opos po nepavykusio kraujo stabdymo endoskopijos metu. Mes nagrinėjometranskateterinės embolizacijos efektyvumą, gydymo baigtis ir rodiklius, galinčius turėti įtakos sergamumui bei mirtingumui.MetodaiAtlikome retrospektyviąją analizę, į kurią įtraukėme 20 pacientų, kuriems nuo 2012 m. iki 2015 m. Respublikinėje Vilniaus universitetinėje ligoninėje buvo atlikta transkateterinė arterinė embolizacija dėl ūminio kraujavimo iš viršutinės virškinamojo trakto dalies. Ieškojome ryšio tarp pakartotinio kraujavimo bei mirštamumo ir pacientų lyties, amžiaus, perpiltų kraujokomponentų vienetų, hospitalizacijos trukmės, laiko iki embolizacijos, atliktos embolizacijos rūšies (profilaktinė ar terapinė).RezultataiEmbolizacijos techninis efektyvumas buvo 100 %. Keturiolikai pacientų (70 %) buvo atlikta profilaktinė ir 6 (30 %) – terapinė embolizacija. Trims (15 %) pacientams po embolizacijos pasikartojo kraujavimas. Penki (25 %) pacientai mirė. Pacientams, kurie vėliau mirė, buvo perpilta statistiškai reikšmingai daugiau kraujo komponentų vienetų (šviežiai šaldytos plazmos p=0,04;eritrocitų masės p=0,01), jų hospitalizacija buvo ilgesnė (p=0,05). Statistiškai reikšmingų veiksnių, galinčių turėti įtakos pakartotinio kraujavimo dažniui, neradome.IšvadosTranskateterinė arterinė embolizacija yra tinkamas metodas po endoskopinio gydymo pasikartojusiam kraujavimui iš skrandžio ar dvylikapirštės žarnos opų gydyti. Nors šis būdas pasižymi dideliu techniniu ir klinikiniu efektyvumu ir mažu komplikacijų dažniu, tačiau reikalingi tolesni atsitiktinių imčių tyrimai šio gydymo būdo tinkamumui pagrįsti

Complications after Loop Ileostomy Closure: A Retrospective Analysis of 132 Patients

&lt;b&gt;&lt;i&gt;Background: &lt;/i&gt;&lt;/b&gt;Closure of a loop ileostomy is a relatively simple procedure although many studies have demonstrated high morbidity rates following it. Methods to reduce the number of complications, such as timing of closure or different surgical closure techniques, are investigated. The aim of this study was to evaluate the experience of the Abdominal Surgery Center at Vilnius University Hospital (VUH) ‘Santariskiu klinikos' to review the complications after closure of loop ileostomy and to identify potential risk factors for postoperative complications. &lt;b&gt;&lt;i&gt;Methods: &lt;/i&gt;&lt;/b&gt;Data from 132 patients who underwent closure of loop ileostomy from 2003 to 2013 at the Abdominal Surgery Center of VUH were collected, including demographics, causes of ileostomy formation, additional diseases, time from creation to closure of ileostomy, anastomotic technique, duration of the operation, postoperative complications, and hospital stay after surgery. The operations were performed by 15 surgeons with varying experience assisted by surgical residents. Experience in ileostomy closure was defined by the number of procedures performed. &lt;b&gt;&lt;i&gt;Results: &lt;/i&gt;&lt;/b&gt;Complications occurred in 24 patients (18.2%), with 20 of them having surgical complications: bowel obstruction (9 (6.8%)), wound infection (4 (3.0%)), peritonitis due to anastomotic leak (3 (2.3%)), intra-abdominal abscess (2 (1.5%)), anastomotic leak with enterocutaneous fistula (1 (0.76%)), and bleeding (1 (0.76%)). 4 patients had non-surgical complications: postoperative diarrhea (2 (1.5%)), urinary retention (1 (0.76%)), and deep vein thrombosis (1 (0.76%)). Most complications were classified as group II according to the Clavien-Dindo classification. 2 patients died (1.5%). The anastomotic technique used did not affect the outcome. The experience of the surgeon as judged by the frequency of the procedure was the main factor affecting postoperative morbidity significantly (p = 0.03). &lt;b&gt;&lt;i&gt;Conclusion: &lt;/i&gt;&lt;/b&gt;Our study revealed that the rate of postoperative complications and a smooth postoperative course after the closure of ileostomy was influenced by surgical experience.</jats:p

Rektovaginalinių fistulių gydymas naudojant Martius lopą: klinikinis atvejis

ĮžangaRektovaginalinė fistulė yra apibūdinama kaip epitelizuota nenormali jungtis tarp tiesiosios žarnos ir makšties. Ši fistulė sudaro&nbsp;apie 5 % visų tiesiosios žarnos ir išangės fistulių. Dažniausios rektovaginalinės fistulės atsiradimo priežastys yra gimdymotraumos, lėtinės uždegiminės žarnų ligos, žema priekinė tiesiosios žarnos rezekcija, hemorojinių mazgų ir dubens srities chirurgija.&nbsp;Gydymo galimybių yra daug: endorektalinis, transvaginalinis ar transperinealinis uždarymas, pažeistos vietos rezekcija,gydymas autologinėmis kamieninėmis ląstelėmis, fistulės drenavimas ar graciloplastika. Esant žemai rektovaginalinei&nbsp;fistulei, Martius lopas yra tinkamas pasirinkimas dėl gerų pooperacinių rezultatų bei mažo donorinės vietos kosmetinio irfunkcinio pažeidimo.Klinikinis atvejisPacientei buvo diagnozuotas žemas tiesiosios žarnos navikas ir po neoadjuvantinės chemoradioterapijos atlikta priekinė&nbsp;tiesiosios žarnos rezekcija bei suformuota prevencinė ileostoma. Tos pačios hospitalizacijos metu ileostoma uždaryta. Pooperaciniu&nbsp;laikotarpiu atsirado rektovaginalinė fistulė. Tuomet pacientė gavo adjuvantinę chemoterapiją. Po jos atlikta graciloplastika&nbsp;ir suformuota ileostoma. Po dviejų mėnesių rektovaginalinė fistulė vėl pasikartojo. Dėl rektovaginalinės fistulėsrecidyvo alikta Martius lopo operacija. Praėjus mėnesiui po operacijos, apžiūrėdamas pacientę chirurgas rektovaginalinės&nbsp;fistulės recidyvo nerado.IšvadosMartius lopo technika naudojant riebalinio audinio lopą yra tinkamas pasirinkimas gydant rektovaginalines fistules.Reikšminiai žodžiai: rektovaginalinė fistulė, Martius lopasThe Martius flap for repair of low rectovaginal&nbsp;fistula: a case reportDonatas Danys, Narimantas Evaldas Samalavičius, Gytis Žaldokas, Edgaras Smolskas BackgroundRectovaginal fistula is defined as an epitheliumlined abnormal communication between the rectum and the vagina. It is reported to represent approximately 5% of all anorectal fistulas. The most common causes of rectovaginal fistulas are obstetric traumas, chronic inflammatory bowel diseases, low anterior rectal resection, hemorrhoid and pelvic surgery. There are many treatment options, such as endorectal, transvaginal or transperineal closure, resection of the affected part, treatment with autologous stem cells, seton drainage or graciloplasty. For low fistulas, the Martius flap is referred to as an excellent choice of tissue transfer with no functional and low cosmetic deficit of the donor site.Case reportA patient was diagnosed with low rectal cancer and after neoadjuvantive chemoradiotherapy underwent anterior rectal resection. Preventive ileostomy was made. Later, due to the fluent postoperative progress, ileostomy closure was performed. In the postoperative period, a rectovaginal fistula occurred. Then, the patient was given adjuvantive chemotherapy. After that, graciloplasty for the rectovaginal fistula and ileostomy were performed. After two months, a rectovaginal fistula occurred again, and the Martius flap repair was performed.ConclusionThe Martius flap technique using a fat pad flap is a decent choice for low rectovaginal fistulas. A well vascularised interposition flap between the vagina and the rectum gives good results.Key words: rectovaginal fistula, the Martius fla

Porezekcinio tiesiosios žarnos sindromo dažnis naudojant žemos priekinės tiesiosios žarnos rezekcijos skalę (LARS skalę)

Background  Up to 90 % of patients undergoing low anterior resection, complain of increased daily bowel movements, urgency for def­ecation, and a variable degree of incontinence. A symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer has recently been validated in Lithuanian population.  Purpose: we aimed to measure the incidence and severity of the anterior resection syndrome (ARS) using LARS and its cor­relation with selected variables or risk factors.Methods  LARS score was sent to 183 patients who underwent low anterior resection with TME with coloanal anastomosis from January 1st, 2008 to December 31st, 2012 at the National Cancer Institute. Of them 111 (responsibility was 60.7%) have completed the questionnaire. The variables studied were age, sex, location of the tumour, neoadjuvant radiotherapy, time after treatment.Results  Of 111 questionnaires 108 were completed properly (59.0%). 27 patients (25%) had no ARS, 26 (24%) had minor ARS and 55 (56%) had major ARS. In univariate analysis age, sex, neoadjuvant radiotherapy, and tumour localization did not have an im pact on severity of bowel dysfunction symptoms after low anterior resection with TME. Also there was no difference between female and male patient groups (p=0.33), patients who had/had not undergone radiation therapy (p=0.07), and those with low or high tumour edge level (p=0.17). However, time after operation (&lt; 12 months) was associated to ARS.Conclusion  More than half of the operated patients presented severe LARS score and only a one fourth did not provide a quantifiable ARS. Timing after surgery was the main factor affecting ARS. Įvadas Iki 90 proc. pacientų, operuotų dėl tiesiosios žarnos navikų, skundžiasi padažnėjusio tuštinimosi epizodais, nesulaikomu noru tuštintis, įvairaus laipsnio išmatų nelaikymu. Visai neseniai tuštinimosi sutrikimų skalė šiems simptomams vertinti buvo iš­versta į lietuvių kalbą ir patvirtinta naudoti klinikinėje praktikoje.Tyrimo tikslas Mūsų tikslas buvo nustatyti porezekcinio tiesiosios žarnos sindromo (ARS) pasireiškimo dažnį ir sunkumą pacientams po tie­siosios žarnos rezekcijos bei išsiaiškinti rizikos veiksnius.Metodai Porezekcinio tiesiosios žarnos sindromo skalė buvo išsiųsta 183 pacientams, kuriems nuo 2008 m. sausio 1 d. iki 2012 m. gruodžio 31 d. Nacionaliniame vėžio institute buvo atlikta tiesiosios žarnos rezekcija su totaline mezorektaline ekscizija su­formuojant žarnos jungtį. Iš jų skalę užpildė 111 (atsakomumas – 60,7 %). Kartu tyrėme šiuos galimus blogesnės tuštinimosi funkcijos rizikos veiksnius: lytis, amžius, naviko aukštis, priešoperacinis spindulinis gydymas, laikas po operacijos.Rezultatai Iš 111 užpildytų klausimynų 108 buvo užpildyti tinkamai (59 %). 27 pacientams (25 %) ARS nepasireiškė, 26 (24 %) pasireiškė silpnas ARS, o net 55 (56 %) – ryškus. Išanalizavę rizikos veiksnius nustatėme, jog tik laikas po operacijos buvo lemiamas veiks­nys ARS po operacijos pasireikšti (ilgesnis laikas, ne tokie ryškūs simptomai).Išvados Daugiau nei pusei pacientų atsirado ryškus tuštinimosi sutrikimas ir tik ketvirtadalis neturėjo jokių skundų. Laikas, praėjęs nuo operacijos, buvo vienintelis teigiamas veiksnys šiems simptomams susilpnėti

Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

Background Although the incidence of iatrogenic colonoscopic perforation is low, it can result in severe complications and mortality. This study assessed the incidence and surgical management outcomes of iatrogenic colonic perforations.Materials and Methods We reviewed all the medical records of patients with colonic perforations during diagnostic or therapeutic colonoscopies from January 2007 to December 2016 at National Cancer Institute. We collected the patient’s demographic data, colono­scopic reports, and data regarding the location of perforations, their treatment and outcome.Results 16 186 colonoscopies were performed at National Cancer Institute. The overall perforation rate was 0.14% (23 of 16 186). Of the total 23 colon perforations, 20 were managed operatively. The most common location was the sigmoid colon, in 12 cases. The most used surgical technique was simple suture (11 cases) followed by resection with anastomosis (6 cases). Three patients died (one because of multiple organ failure caused by acute bronchopneumonia and two patients with intra-abdominal sepsis died due cardiopulmonary insufficiency).Conclusions: If surgery and its associated morbidity can be avoided in cases of colonic perforation the negative impact of a colonoscopy-associated complication can be minimized considerably. Patients need to be informed of the complications of colonoscopy, and clinicians must be cautioned about the potential problems for patients with a high anaesthetic risk when performing the procedure.Įvadas Nors kolonoskopinių gaubtinės žarnos perforacijų dažnis nėra didelis, tačiau jos gali lemti sunkias komplikacijas ar net mirtį. Šios studijos tikslas buvo įvertinti kolonoskopinių gaubtinės žarnos perforacijų dažnį ir jų chirurginio gydymo rezultatus.Metodai Retrospektyviai buvo peržiūrėti duomenys pacientų, kuriems atliekant diagnostinę ar gydomąją kolonoskopiją Nacionalinia­me vėžio institute nuo 2007 m. sausio 1 d. iki 2016 m. gruodžio 31 d. įvyko gaubtinės žarnos perforacijos. Analizuoti pacientų demografiniai rodikliai, kolonoskopijos duomenys, informacija apie jų gydymą ir gydymo rezultatus.Rezultatai Iš viso Nacionaliniame vėžio institute minėtu laikotarpiu buvo atlikta 16 186 kolonoskopijos. Bendras kolonoskopinių gaubti­nės žarnos perforacijų dažnis siekė 0,14 % (23 iš 16 186 pacientų). Iš šių 23 perforacijų 20 atvejų buvo taikytas chirurginis gy­dymas. Daugiausiai perforacijų įvyko riestinėje žarnoje (12 atvejų). 11 atvejų defektas žarnoje buvo užsiūtas, 6 atvejais atlikta žarnos rezekcija su pirmine anastomoze. Viena mirtis įvyko dėl ūmios bronchopneumonijos išsivysčius dauginiam organų dis­funkcijos sindromui, kiti du pacientai, kuriems pasireiškė pilvo ertmės sepsis, mirė nuo kardiopulmoninio nepakankamumo.Išvados Jeigu kolonoskopinės gaubtinės žarnos perforacijos atvejais pavyktų išvengti operacijos ir ją lydinčių sunkių komplikacijų, tai leistų reikšmingai sumažinti kolonoskopijos komplikacijos padarinius. Visus pacientus prieš procedūrą būtina įspėti apie galimas komplikacijas, o gydytojai turi būti itin atidūs, jei pacientas priklauso didelės rizikos grupei

Tight Cutting Seton for Anal Fistulae Revisited

Background: Anal fistulas are a common medical problem affecting thousands of patients annually well over 2000 years. There are many new novel approaches to this old condition but none with overwhelming success and low complication rates. The aim of this retrospective review was to revisit our experience in the treatment of anal fistulas with a tight cutting seton. Objectives: Observational study of retrospective collected data. Design: Retrospective study. Patients and Methods: Between 2008 - 2018 a retrospective study included all patients with primary or recurrent fistulas who were treated using tight seton were analyzed. Main Outcome Measures: The primary outcomes measured were healing rate, procedure-related complications, and incontinence. Sample Size: The study included 41 cases of anal fistula treated with a tight cutting and complete records of follow-up. Results: Firty-one patients with a median age of 37.9 years with a median follow up of 14.37 months were identified and included in the study. Among these, 66% of the fistulas were primary and 34% persisting or recurrent fistulas. Fistulas were classified as trans-sphincteric in 71% of patients, inter-sphincteric in 20%, horseshoe in 7%, and extra-sphincteric in 2% of the patients. All patients were treated with a cutting seton. The total healing rate was 95%. Two patients developed a persistent fistula. Four patients (9.8%) complained of different degrees of incontinence. There were no incidents of solid stool incontinence. In one case, the cause of fecal incontinence was keyhole deformity which was resolved after a buried island transposition flap. Conclusion: Our study evaluates a series of patients who were treated by a single surgeon in nonrandomized studies, emphasizing that tight cutting seton technique first described by Hippocrates in 430 BCE is a simple, highly effective, and safe procedure that should not be abandoned. Limitations: This study has limitations, including its retrospective nature. We collected data for this study from electronic records and databases of patients after completion of followup. Conflict of Interest Statement: The authors declare that there is no conflict of interests in this study

Quality of life after subtotal gastrectomy for gastric cancer: Does restoration method matter? – A retrospective cohort study

Introduction: The aim of this study was to evaluate the impact on the quality of life (QoL) status of three gastrointestinal continuity restoration methods following a subtotal gastrectomy in patients with gastric cancer. Methods: QoL data from 153 patients were obtained and evaluated in this retrospective cross-sectional case series study. A list of patients who responded to questionnaires on QoL was stratified into three arms based on which gastrointestinal continuity restoration method was used – Billroth I (n = 37), Roux-en-Y (n = 15), and Balfour (n = 101). Results: The mean global health status scores for the patients following the Billroth I, Roux-en-Y and Balfour reconstructive surgery arms were 62 ± 20.09, 61 ± 24.08 and 56 ± 21.2, respectively, (p = 0.182). The mean scores of the functional scales were not lower than 60 in any of the patient groups. For physical, role, cognitive, social functional scales, the Billroth I method had the best mean QoL score. Comparisons of the global QoL, functional activities, and majority of the postgastrectomy symptom scores at different time points after the surgeries (6–12 months vs > 1 year) did not reveal major significant differences between the groups. However, the results highlighted trends and ranked the gastrointestinal continuity restoration methods over time. Conclusions: The best QoL scores were obtained from the patients who underwent the Billroth I surgery. The Roux-en-Y method was better than the Balfour method 6–12 months after surgery. However, the Balfour method was better than the Roux-en-Y after one year. Further prospective randomized controlled trials are needed

Transanal endoscopic microsurgery for rectal adenomas: single center experience

Introduction: Transanal endoscopic microsurgery (TEM) is a method of choice for the local treatment of rectal adenomas. Though generally considered as a safe method, some authors have expressed skepticism about the anorectal function following TEM. Aim: To review our experience in using TEM for removal of rectal adenomas. We focused on morbidity, local recurrence rates, and anorectal function following the operation. Material and methods : The study included 72 patients who underwent TEM for rectal adenomas from December 2009 to November 2014 at the Department of Surgical Oncology, National Cancer Institute. Of the 72 patients, 31 (43.1%) were lost in the follow-up. We recorded the demographics, operative details, final pathology, post-operative length of stay, post-operative complications, recurrences and functional outcome for each of the 41 (56.9%) remaining participants. Results : Of the 41 eligible patients, 19 (46.3%) were male and 22 (53.7%) were female. The mean age of our patients was 66.8 years. There were no intraoperative complications. In 4 (9.8%) cases, postoperative complications were observed – urinary retention (2 cases, 4.9%) and postoperative hemorrhage (2 cases, 4.9%). All complications were treated conservatively. There was a single case (2.4%) of adenoma recurrence during the follow-up period. The mean score of the FISI questionnaire was 7.6 ±9.2 (ranging from 0 to 36), and the mean Wexner score was 2.3 ±3.4 (ranging from 0 to 17). Conclusions : Transanal endoscopic microsurgery in our experience demonstrated low complication and recurrence rates, and good functional results. We conclude that TEM is an effective and safe method for the treatment of rectal adenomas

Transanal endoscopic microsurgery for rectal adenomas: single center experience

Introduction: Transanal endoscopic microsurgery (TEM) is a method of choice for the local treatment of rectal adenomas. Though generally considered as a safe method, some authors have expressed skepticism about the anorectal function following TEM. Aim: To review our experience in using TEM for removal of rectal adenomas. We focused on morbidity, local recurrence rates, and anorectal function following the operation. Material and methods : The study included 72 patients who underwent TEM for rectal adenomas from December 2009 to November 2014 at the Department of Surgical Oncology, National Cancer Institute. Of the 72 patients, 31 (43.1%) were lost in the follow-up. We recorded the demographics, operative details, final pathology, post-operative length of stay, post-operative complications, recurrences and functional outcome for each of the 41 (56.9%) remaining participants. Results : Of the 41 eligible patients, 19 (46.3%) were male and 22 (53.7%) were female. The mean age of our patients was 66.8 years. There were no intraoperative complications. In 4 (9.8%) cases, postoperative complications were observed – urinary retention (2 cases, 4.9%) and postoperative hemorrhage (2 cases, 4.9%). All complications were treated conservatively. There was a single case (2.4%) of adenoma recurrence during the follow-up period. The mean score of the FISI questionnaire was 7.6 ±9.2 (ranging from 0 to 36), and the mean Wexner score was 2.3 ±3.4 (ranging from 0 to 17). Conclusions : Transanal endoscopic microsurgery in our experience demonstrated low complication and recurrence rates, and good functional results. We conclude that TEM is an effective and safe method for the treatment of rectal adenomas