title: Transanal endoscopic microsurgery: safe for midrectal lesions in morbidly obese patients.
abstract: BACKGROUND
  Transanal endoscopic microsurgery is a safe option for proximal rectal tumors in morbidly obese patients for whom transabdominal pelvic dissection often is fraught with morbidity.
  
  
  METHODS
  From a database of 318 patients who underwent transanal endoscopic microsurgery, we report a retrospective case-control study of 9 patients with a body mass index range of 35 to 66 with sessile rectal lesions 6 to 15 cm from the anal verge who underwent transanal endoscopic microsurgery. Case subjects were compared with 15 controls and matched for age, tumor type, and level of tumor. The average body mass index of controls was 30 (P < .001). By using t test analysis, perioperative outcomes (surgical time, blood loss, and hospital length of stay) and postoperative complications were compared.
  
  
  RESULTS
  Sessile tumors were located 7 to 11 cm from the anal verge with a diameter of 1 to 4 cm. Patient and tumor factors such as age, distal tumor margin from anal verge, and tumor diameter were not significantly different between case subjects and controls. Surgical blood loss, surgical time, and hospital length of stay were not significantly different between the 2 groups. One complication occurred among the cases. No complications occurred in the control group. All patients had complete surgical resections with negative margins.
  
  
  CONCLUSIONS
  Transanal endoscopic microsurgery in morbidly obese patients is a safe, feasible, and a viable alternative to low anterior resection.
authors.affiliation: Section of Colon and Rectal Surgery, Washington Hospital Center, 106 Irving St. NW, Suite 2100N, Washington, DC 20020-2975, USA. askumarmd@gmail.com
authors.forename: Anjali S
authors.initials: AS
authors.lastname: Kumar
authors.forename: Nandita
authors.initials: N
authors.lastname: Chhitwal
authors.forename: Jasna
authors.initials: J
authors.lastname: Coralic
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Stahl
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Ayscue
authors.forename: James F
authors.initials: JF
authors.lastname: FitzGerald
authors.forename: Lee E
authors.initials: LE
authors.lastname: Smith
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D001003:Anal Canal; D015992:Body Mass Index; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D020700:Proctoscopes; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies