Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program

Serra‐Aracil, Xavier; Labró-Ciurans, Maritxell; Rebasa, Pere; Mora, Laura; Pallisera‐Lloveras, Anna; Serra, S.; Gràcia-Roman, Raquel; Navarro‐Soto, Salvador

doi:10.1007/s00464-018-6432-5

Cited by 21 publications

(26 citation statements)

References 29 publications

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“…We believe that the description of postoperative complications should apply the same classification to allow comparison of the results. The Clavien-Dindo classification [7] is probably the most widely used in the literature; the Comprehensive Complication Index (CCI) [12] is useful for completing the description of complications in procedures associated with high morbidity, but in TEM it is of little value [6] .…”

Section: Resultsmentioning

confidence: 99%

“…Since January 2005, morbidity has been prospectively recorded in all patients admitted to the Colorectal Unit and the Department of General and Digestive Surgery at our hospital [6] . The assessment of adverse effects is peer-reviewed.…”

Section: Secondary Variablesmentioning

confidence: 99%

“…This is a common occurrence and is considered normal within the process. Therefore, it is important to define the concept of rectal bleeding [6] . Table 4 shows that rectal bleeding is the most frequent complication, accounting for 72.8% (115/158) of the total complications.…”

Section: Rectal Bleedingmentioning

confidence: 99%

“…However, the absence of standardization in the recording and the description of the complications makes the results of different studies difficult to compare. A previous study by our group [6] reported a morbidity rate of 23.6%, grouped according to the Clavien-Dindo classification (Cl-D) [7] . More than half of these complications (Cl-D grade I) required observation alone, and clinically relevant morbidity (Cl-D ≥ II) was recorded in only 5.6% of the patients.…”

Section: Introductionmentioning

confidence: 99%

“…The most frequent complications after TEM are rectal bleeding (as in the study just mentioned) [6] or urinary morbidity, with reported rates ranging between 5.9% and 10.8% [8,9] .…”

Section: Introductionmentioning

confidence: 99%

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Management of the main postoperative surgical complications after transanal endoscopic microsurgery: an observational study

Serra‐Aracil¹,

Mora-López²,

Pallisera‐Lloveras³

et al. 2019

MIS

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Aim: Rates of clinically relevant postoperative morbidity after transanal endoscopic microsurgery (TEM) are low. For this reason, there are few descriptions in the literature on the management of these complications. Because of this lack of information, their importance may be either underestimated or overestimated (in the latter case, leading to overtreatment). The present article reports the frequency of the occurrence of postoperative surgical complications after TEM and describes various approaches to their management.Methods: An observational study was carried out with prospective data collection and retrospective analysis from June 2004 to June 2019, including all patients undergoing TEM for rectal tumors. All postoperative complications were recorded using the Clavien-Dindo classification (Cl-D), as well as preoperative, surgical, postoperative, and pathological variables. Results:During the study period, 778 patients underwent TEM, of whom 716 met the inclusion criteria. Postoperative morbidity was 22.1% (158/716). Clinically relevant morbidity (Cl-D > II) was 5% (36/716). The most frequent complication was rectal bleeding, occurring in 115/716 (16.1%) patients; 85 of these 115 (73.9%) patients were grade I Cl-D. Urinary complications were rare (30/716, 4.2%). Similarly, infectious complications of perianal and pelvic abscesses appeared in 7/716 (1%) patients, two of whom required colostomy. Conclusion:Clinically relevant complications after TEM are rare. For this reason, experience of these complications is limited. Here, we propose a management protocol to ensure that these complications are neither underestimated nor subjected to excessively aggressive or unnecessary treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Secondary Variablesmentioning

confidence: 99%

Section: Rectal Bleedingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The most frequent complications after TEM are rectal bleeding (as in the study just mentioned) [6] or urinary morbidity, with reported rates ranging between 5.9% and 10.8% [8,9] .…”

Section: Introductionmentioning

confidence: 99%

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Management of the main postoperative surgical complications after transanal endoscopic microsurgery: an observational study

Serra‐Aracil¹,

Mora-López²,

Pallisera‐Lloveras³

et al. 2019

MIS

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Transanal Endoscopic Surgery for Benign Rectal Lesions: Preparation and Surgical Techniques

deBeche-Adams

2019

The SAGES Manual of Colorectal Surgery

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Is Local Resection of Anal Canal Tumors Feasible with Transanal Endoscopic Surgery?

et al. 2019

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Background An important drawback of local surgery for lesions in the anal canal is the difficulty of achieving en bloc full‐thickness resections. The aim of this study is to evaluate TEM/TEO in lesions of this type from the point of view of morbidity, mortality and the quality of the pathology specimen. Methods This is an observational study with prospective data collection from June 2004 to July 2018. Two groups are defined: group A (rectal tumors with proximal margin between 0 and ≤4 cm from anal verge) and group B (distal margin > 4 cm from anal verge). A technical description is provided; resections and postoperative complications in both groups are compared. Results During the study period, 757 patients underwent TEM/TEO. Finally, 692 patients were included, 192 patients in group A and 500 patients in group B. An en bloc surgical specimen was obtained in 176/192 patients (91.7%), although the defect was completely sutured in 132 (68.8%). In the comparative analysis, group A did not present significantly greater fragmentation of the resected piece [16/192 (8.3%) vs. 36/500 (7.2%), p = 0.630], although group A was associated with greater involvement of the surgical margin [28/192 (14.6%), 32/500 (6.4%), p = 0.001] and clinically relevant morbidity [16/192 (8.3%), 20/500 (4%), p = 0.034]. There was no mortality. Conclusions The use of TEM/TEO to remove lesions originating in the anal canal is feasible. But we have to take into account that there is an increase in complications, technical difficulties and affected margins resection.

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Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program

Abstract: TEM is a safe procedure. The low rates of morbidity, re-hospitalization, and postoperative complications in the first 2 days after surgery make the procedure suitable for A-OdS.

Cited by 21 publications

References 29 publications

Management of the main postoperative surgical complications after transanal endoscopic microsurgery: an observational study

Management of the main postoperative surgical complications after transanal endoscopic microsurgery: an observational study

Transanal Endoscopic Surgery for Benign Rectal Lesions: Preparation and Surgical Techniques

Is Local Resection of Anal Canal Tumors Feasible with Transanal Endoscopic Surgery?

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