[Anorectal disorders in the immediate and late postoperative period after transanal endoscopic microsurgery].
OBJECTIVE
Transanal endoscopic microsurgery (TEM) is a new technique for local excision of benign and incipient malignant rectal lesions. This technique offers technological advantages over other procedures and is associated with lower morbidity and mortality. TEM involves prolonged dilatation of the anal sphincter with a large-diameter (4 cm) operating rectoscope. The aim of the present study was to assess the effects of TEM on anorectal function.


METHODS
All patients undergoing TEM were included. Continence was scored by a numeric scale and anorectal manometry before surgery and 3 weeks and 4 months after surgery. Variations in anal resting pressure, maximal anal resting pressure and the anal continence questionnaire were evaluated.


RESULTS
Sixty-eight patients underwent TEM between June 2004 and August 2006. Mean anal resting pressure (ARP) and maximal anal resting pressure (MARP) were significantly reduced at 3 weeks after surgery (ARP/MARP before surgery: 38.89/126.28; 3 weeks after surgery: 26.61/104.75). No significant change was found in the mean continence score. No association was found between variation in pressures and operating time.


CONCLUSIONS
TEM produced statistically significant alterations in anorectal physiology studies which returned to normal at 4 months. The technique did not affect continence scores in the immediate or late postoperative period and consequently can be considered a safe procedure that does not produce significant alterations in anorectal function.
Mora López
Laura
L
Servicio de Cirugía General, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España. Lmora@cspt.es
Serra Aracil
Javier
J
Rebasa Cladera
Pere
P
Puig Divi
Valentí
V
Hermoso Bosch
Judith
J
Bombardo Junca
Jordi
J
Alcántara Moral
Manuel
M
Hernando Tavira
Rubén
R
Ayguavives Garnica
Isidro
I
Navarro Soto
Salvador
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000502:physiology*; D003627:Data Interpretation, Statistical; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications; D020700:Proctoscopes; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors