title: Complications of transanal endoscopic microsurgery are rare and minor: a single institution's analysis and comparison to existing data.
abstract: BACKGROUND
  Transanal endoscopic microsurgery, a minimally invasive procedure for treatment of early-stage rectal cancer, carcinoid tumors, and adenomas, is shown to be a safe procedure with very low perioperative morbidity.
  
  
  OBJECTIVE
  We aimed to compare the outcomes of transanal endoscopic microsurgery at a large volume tertiary care center with the existing literature.
  
  
  METHODS
  We retrospectively reviewed a prospectively collected database of 325 transanal endoscopic microsurgery procedures and looked for risk factors associated with complications. Indications for transanal endoscopic microsurgery included rectal adenocarcinomas, adenomas, and carcinoids.
  
  
  METHODS
  Procedures were performed by a single surgeon at a large-volume tertiary care center.
  
  
  METHODS
  Patients were enrolled over a 20-year period, and data were collected on demographics, perioperative details, tumor characteristics, and complications.
  
  
  METHODS
  Transanal endoscopic microsurgery was performed on all 325 patients.
  
  
  METHODS
  Main outcome measures were urinary retention, late bleeding requiring intervention, dehiscence, peritoneal cavity entry, conversion to abdominal approach, fecal soiling, and rectovaginal fistula.
  
  
  RESULTS
  Intraoperative bleeding was associated with larger tumor size, whereas postoperative bleeding requiring intervention was not associated with any factors studied. Peritoneal cavity entry and urinary retention were more likely if the tumor was in either the anterior or lateral position in the rectum. The peritoneal cavity was entered in 9 patients, and conversion to abdominal approach occurred in 1 patient. Intraoperative bleeding, by surgeon's choice, and urinary retention, by patient's choice, were associated with a greater likelihood of admission to the inpatient ward. Fecal soiling was not reported by patients and not recorded.
  
  
  CONCLUSIONS
  This study was limited because it was a retrospective analysis
  
  
  CONCLUSIONS
  Transanal endoscopic microsurgery is an extremely safe procedure, offering very low perioperative morbidity. The overall morbidity found in our study was 10.5%, on par with published data for large series of 21%, 7.7%, and 14.9%. In contrast, complications from radical resection are reported at 18% to 55%.
authors: MedStar Washington Hospital Center, Section of Colon and Rectal Surgery, Washington, DC 20020-2975, USA. askumarmd@gmail.com
authors: Anjali S
authors: AS
authors: Kumar
authors: Jasna
authors: J
authors: Coralic
authors: Deirdre C
authors: DC
authors: Kelleher
authors: Shafik
authors: S
authors: Sidani
authors: Kirthi
authors: K
authors: Kolli
authors: Lee E
authors: LE
authors: Smith
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D002276:Carcinoid Tumor / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult