RESUMO
AIM: Transanal endoscopic microsurgery (TEM) was originally invented by Buess et al. (Chirurg, 1984, 55, 677-80) for the treatment of infraperitoneal rectal adenomas. Its indications have progressively expanded to include larger and more advanced lesions. The aim of the study was to report the results of TEM used for the treatment of circumferential rectal lesions. METHOD: We retrospectively reviewed the medical records of 17 consecutive patients [median age 69 (32-89) years; nine men] who underwent TEM for a circumferential rectal lesion in our department between September 2010 and January 2015. RESULTS: The median distance from the anal verge was 4 (3-11) cm, the median longitudinal extent was 7 (3-10) cm and the median surface area was 75 (40-255) cm(2) . An end-to-end anastomosis without proximal bowel mobilization was completed endoscopically in all cases. The median operating time was 120 (40-240) min. Persistent, endoscopically uncontrollable endoluminal bleeding in one patient was successfully treated with a second TEM procedure. One patient underwent preoperative radiotherapy for adenocarcinoma detected at the preoperative assessment. Surgical histology showed a pT3 cancer in one patient who refused further surgery, a pT2 cancer in two who subsequently underwent abdominoperineal resection, a pT1 cancer in four and a ypT0 in one patient. All are at present free of disease. No patients developed faecal incontinence or urinary or sexual dysfunction. Four patients required endoscopic balloon dilatation for stenosis. CONCLUSION: Transanal endoscopic microsurgery is a feasible and safe technique for large circumferential lesions with a satisfactory outcome. Preoperative staging may be inaccurate.
Assuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Microcirurgia Endoscópica Transanal/métodos , Adenocarcinoma/patologia , Adenoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/epidemiologia , Constrição Patológica/cirurgia , Dilatação , Incontinência Fecal/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Complicações Pós-Operatórias/cirurgia , Doenças Retais/epidemiologia , Doenças Retais/cirurgia , Neoplasias Retais/patologia , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/epidemiologia , Resultado do Tratamento , Carga TumoralAssuntos
Hemorragia Gastrointestinal/terapia , Tumores do Estroma Gastrointestinal/patologia , Hemostase Endoscópica/métodos , Neoplasias Gástricas/patologia , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias Gástricas/cirurgiaRESUMO
Anastomotic leakage after rectal surgery is a very serious complication and is the main cause of postoperative morbidity and mortality. We describe three cases of rectal leakage which we treated with endoscopic vacuum-assisted closure. We used the Endo-SPONGE (B. Braun Aesculap AG, Germany), which consists of an open-cell, cylindrical polyurethane sponge connected to a drainage tube which is linked to a vacuum system to exert constant suction. The possible role of this new tool in the management of anastomotic leaks is also discussed.