Low Anterior Resection Syndrome: A Not Uncommon Complication of Transanal Endoscopic Microsurgery

Michael F Horaist, MD, Philip A Cole Ii, MD, Andrew M Werner, MD FACS, Michael D Stratton, MD FACS, W Reid Grimes, MD FACS, Philip A Cole, MD FACS. LSU Health Shreveport

 

Introduction:
Transanal Endoscopic Microsurgery (TEM) allows for excision of middle and high rectal lesions utilizing a minimally-invasive technique. Low anterior resection syndrome (LARS) includes a constellation of symptoms that typically follows colorectal/coloanal anastomosis. The most pronounced symptoms include frequency, urgency, and/or incontinence. The goal of this study was to review our TEM experience for the treatment of rectal neoplasia and monitor the subsequent development of LARS.
Methods:
100 patients underwent TEM from August 2005 to July 2011 after receiving 2 Fleets enemas on the morning of surgery. All patients were admitted overnight, given clear liquids post-op, and discharged the following morning once tolerating a diet and voiding.
Results:
The average follow-up of these 100 patients was 19.2 months. Complications following this minimally-invasive procedure (including frequency, urgency, bleeding, infection, incontinence, and recurrence) occurred in 16 out of 100 patients. The positive margin rate was 5% leading to an equivalent recurrence rate. LARS occurred in 11/100 patients.
Discussion:
Although better tolerated than more extensive resections, TEM is associated with a risk of functional complications. LARS has traditionally followed resection with low anastamosis; however, TEM has led to similar symptomatology in 16% of our patients. Improvement within one year was noted in 91% of those patients.
 


Session Number: Poster – Poster Presentations
Program Number: P084
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