Peritoneal Perforation During Transanal Endoscopic Microsurgery Is not Associated with Significant Short Term Complications

J Ramkumar¹, A Karimuddin², M Raval², P Phang², C Brown². ¹Division of General Surgery, University of British Columbia, ²Department of Surgery, Section of Colorectal Surgery, St. Paul’s Hospital

Introduction: In patients treated by transanal endoscopic microsurgery (TEM), breach of the peritoneal cavity is feared intraoperative challenge. Our aim is to analyze predictors and outcomes of patients with peritoneal perforation (TEM-P) when compared to similar patients with no peritoneal compromise (TEM-N).

Methods: At St. Paul’s Hospital, demographic, surgical, pathologic, and follow up data for all patients treated by TEM is maintained in a prospectively populated database. Two groups were established for comparison: TEM-P and TEM-N. Statistical analysis was performed using student’s t or chi-squared test, where appropriate.

Results: Of 616 patients treated by TEM, 38 (6%) patients were in the TEM-P group and 578 (94%) in the TEM-N group. There were no differences between the groups in patient age, gender, histology or tumor size. Patients who had peritoneal perforations had more proximal lesions (11 vs 7cm, p <0.0001), anterior lesions (55% vs 45%, p<0.05) and longer operations (73 vs 51mins, p < 0.05). While most defects were closed endoluminally, 2 patients with perforation were converted to trans-abdominal surgery. There was a difference in overall hospital stay with TEM-P patients staying on average 2 days in hospital with fewer patients managed as day surgery (29% vs 72%, p <0.0001). There were no mortalities nor significant 30-day complications in the TEM-P group and only one patient required readmission.

Conclusion: The St. Paul’s Hospital TEM experience suggests patients with peritoneal breach during TEM can be safely managed with outcomes similar to patients with intact mesorectum. Proximal, anterior lesions are at highest risk of peritoneal perforation.

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80244

Program Number: S135

Presentation Session: Colorectal 2

Presentation Type: Podium