Atypical indications for transanal endoscopic microsurgery to avoid major surgery

Abstract

Transanal endoscopic microsurgery (TEM) was originally designed for the removal of rectal tumors, principally incipient adenomas, and adenocarcinomas up to 20cm from the anal verge. However, with the evolution of the technique and the increase in surgeons' experience, new indications have emerged and TEM may now be used in place of other surgical procedures which are associated with higher morbidity. The aim of our study was to evaluate our group's use of TEM or transanal endoscopic operations (TEO) for conditions other than rectal tumors. An observational study of TEM (using Wolf equipment) or TEO (using Storz equipment) for indications other than excision of rectal tumors was conducted from June 2004 to July 2012. Four hundred twenty-four procedures were performed using TEM/TEO: removal of adenocarcinomas in 148 (34.9%) patients, adenomas in 236 (55.7%), post-polypectomy excision in 12 (2.8%), removal of neuroendocrine tumors in 8 (1.9%), and atypical indications in 20 (4.7%). Atypical indications were pelvic abscess (3), benign rectal stenoses (2), rectourethral fistula after prostatectomy (3), gastrointestinal stromal tumor (3), endorectal condylomata acuminata (1), rectal prolapse (2), extraction of impacted fecaloma in the rectosigmoid junction (1), repair of traumatic and iatrogenic perforation of the rectum (2), and presacral tumor (3). The use of TEM/TEO in atypical indications may benefit patients by avoiding surgical procedures associated with greater morbidity.