Fecal Incontinence Quality of Life After Transanal Endoscopic Microsurgery (tem)

INTRODUCTION: TEM is a natural orifice minimally invasive treatment option used to excise a variety of rectal lesions. The procedure requires dilatation of the anal canal to allow placement of the 40mm operating scope, which has the potential for overstretching the sphincter musculature. This combined with partial resection of the rectum and the subsequent loss of rectal volume and compliance creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with their anorectal function is scant. METHODS: A prospectively maintained database of 171 consecutive patients undergoing TEM from 1997 to 2007 was queried to identify TEM patients to survey using the fecal incontinence quality of life scale (Wexner´s Scale) questionnaire. This is a list of 29 questions that are grouped together to test lifestyle, coping, depression and embarrassment secondary to accidental bowel leakage. Higher score represents better function. Thirty patients were deceased and thirty five patients were missing addresses, leaving 106 patients for survey. 20 of the questionnaires did not reach the designated patients leaving a group of 86 patients. Patient satisfaction outcomes were conferred by age ( 75), disease status (cancer versus benign), tumor level in the rectum ( 4cm), excision method (submucosal versus full thickness) and radiation treatment (yes or no). RESULTS: 57 of 86 patients responded (66%). Demographics were as follows: gender: 25 women, 32 men; mean age: 62 years (29 – 88); 42 benign diseases, 15 cancers; mean level in the rectum: 5.2 cm (0 – 17); 14 underwent preoperative radiation, mean dose 4983 cGy (4000-5580 cGy). For lifestyle, coping, depression, embarrassment, respectively, the group scored 2.28, 3.5, 3.1 and 3.4. Patients who underwent submucosal excision (n = 7) scored better on the lifestyle scale compared to the FTLE patients (3.4 vs. 2.1, p= 0.002). Younger patients scored better on coping than older patients (3.6 vs. 3.2, p= 0.03). Cancer patients scored lower on depression (2.7 vs. 3.5, p= 0.001) and coping (3.2 vs. 3.7, p=0.03). There was no difference between groups based on level of the lesion in the rectum or whether radiation therapy was used. CONCLUSION: A patient response based questionnaire study following TEM suggests that TEM as a treatment option results in high patient satisfaction with their fecal continence. Younger patients and those undergoing submucosal excision fared better. Surprisingly, low lesions and radiation treatment did not impact patient fecal continence satisfaction after TEM.

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Program Number: P181

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