Study of anorectal function after transanal endoscopic surgery

Abstract

The sustained, controlled anal dilatation produced with TEM caused statistically significant decreases in VCP and BP one month and four months after surgery. However, the Wexner questionnaire scores did not show any association with clinical incontinence. No predictors of postoperative incontinence were observed. We conclude that TEM is a safe technique and does not affect continence.

Anal function after endoluminal locoregional resection by transanal endoscopic microsurgery and radiotherapy for rectal cancer

“…Several studies have investigated the functional results after TEM, hypothesizing the risk of anal dysfunction secondary to internal sphincter damage due to the 4cm diameter rigid rectoscope used in TEM [9,[17][18][19][20][21][22][23][24][25]. Other studies have reported that irradiation of rectal tumours or other pelvic cancers, such as prostate cancer in men or cervical cancer in women, could affect anorectal function [26].…”

“…Unlike previously published studies the present one included irradiated patients as we hypothesized that radiotherapy together with trans-anal surgery might be detrimental to anorectal function as opposed to surgery alone [9,[17][18][19][20][21][22][23][24][25]. Patients with T2-T3N0 rectal cancer could be included in the study since, as previously reported [7,8], the technique employed (ELRR), together with n-CRT, showed a similar oncological outcome to TME.…”

“…Since anal pressure is restored 4-6 months after surgery it is likely that any acute postsurgical damage to the internal anal sphincter is subsequently recovered [9,22,25]. Such an interpretation is supported by previous findings that, after TEM, anorectal dysfunction is only temporary, with remission within 1 year [9,[17][18][19][20][21][22][23][24][25]. Allaix et al [23] reported a long-term manometric evaluation up to 5 years after TEM, without significant differences compared with 1 year after surgery (Table 8).…”

“…The evaluation of anal function and continence in patients who have undergone TEM has aroused much interest due to the anal stretching caused by the 4‐cm diameter rigid rectoscope employed during the procedure . However, it has been reported that damage of anorectal function after n‐CRT may cause defaecatory dysfunction such as frequent defaecation, urgency and incontinence after sphincter‐preserving procedures .…”

The limits of TEM and beyond – a video vignette

“…Complications such as peritoneal perforation can be managed by TEM and a 360° resection can be closed and heals with minimal stenosis, even after prior radiotherapy. These add to the benefits of TEM (a minimally invasive procedure with low morbidity and mortality, short length of stay and improved organ preservation rate with adequate function) . However, compared with rectal resection, this comes with an increased risk of local recurrence and the need for neoadjuvant treatment to downsize and downstage the tumour.…”