Complications of transanal endoscopic microsurgery (TEMS): a prospective audit.
BACKGROUND
The aim of this study was to determine the postoperative complications of Transanal Endoscopic Microsurgery (TEMS) excision of rectal lesions.


METHODS
A prospective audit of 262 consecutive TEMS procedures performed by a single surgeon between 1999 and 2008.


RESULTS
The mean age of patients was 72 years. The mean area of the lesions excised was 17.5 cm(2) with a mean diameter of 4.5 cm at a mean distance of 7.4 cm from the dentate line. There were 201 full thickness excisions, 51 partial thickness excisions and nine were mixed or unclassified. Thirty-three (13%) patients developed 41 complications. There were two (0.8%) deaths within 30 days. Pelvic sepsis occurred in seven (3%) patients and was significantly more common after excision of low lesions within 2 cm of the dentate line. Postoperative haemorrhage occurred in seven (3%) patients and was significantly less common when dissection was performed with ultrasonic dissection than with diathermy. Fourteen (5%) patients developed acute urinary retention. Four (1.5%) patients developed rectal stenosis and four (1.5%) suffered uncomplicated surgical emphysema that required no treatment.


CONCLUSIONS
Transanal endoscopic microsurgery is a safe operation with a low mortality and morbidity. Pelvic sepsis is more common after excision of lesions within 2 cm of the dentate line. Ultrasonic dissection is associated with less postoperative haemorrhage than diathermy.
Department of Colorectal Surgery, St Richard's Hospital, Spitalfield Lane, Chichester, West Sussex PO19 6SE, UK.
M B
MB
Bignell
A
A
Ramwell
J R
JR
Evans
N
N
Dastur
J N L
JN
Simson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D009666:Nose; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult