Transanal endoscopic excision of rectal tumors is an accepted sphincter preserving technique in rectum surgery. Detailed preoperative diagnostic procedures (histopathology, endosonography) and functional assessment (manometry, electromyography) are crucial for proper patients selection. Aim: To determine clinical and functional results of patients undergoing local excision for benign and malign lesions. Material and Methods: 90 patients (54 male, 46 female, mean age 68.4) treated for rectal tumor with transanal endoscopic rectal microsurgery technique at Department of Surgery. To avoid postoperative sphincter dysfunction NO ointment was routinely applied. Results: 75 patients were operated on for benign recital tumors, 6 for malign disease (T1) and 4 patients due to miscelanous reasons (solitary ulcers, rectum stenosis, rectovaginal fistula). Full-thickness excision was performed on 76 patients and submucosal local excision on 14. The mean distance from the anal verge was 10.6 cm. 34% of the lesions were located on the anterior wall, 40% on the posterior and 17% on the side wall. The mean operative time was 80 min (range 30 – 180 min). Average blood loss was 45 ml (range 0 – 150 ml). The mean length of stay was 3.6 days (range 1–11 days). Peri- and postoperative mortality was 0,0%. Complication included urinary retention (4), bleeding (2), wound dehiscence (1), rectocutaneous fistula (1). Postoperative fecal incontinence was observed in 3 patients. In the follow-up time between 6 and 46 months local recurrence rate reached 6,7% in the adenoma group and up to 30% in the malign diseases group. Conclusions: Transanal endoscopic rectal operation is a safe and cost efficient procedure for local excision of selected patients with rectal tumors. It significantly reduces the number of postoperative functional disturbances what allows to maintain good quality of life with acceptable local recurrence rate and postopeative morbidity. Sphincter protection using nitroglicerin ointment reduces also almost entirely possibility of sphincter damage due to introduction of operational rectoscope.
Program Number: P154