title: Repeated transanal endoscopic microsurgery is feasible and safe.
abstract: BACKGROUND
  The benefits of transanal endoscopic microsurgery (TEM) for the excision of benign and low-grade malignant lesions in the low and middle rectum are well recognized. This study examined the feasibility and safety of a repeated TEM procedure.
  
  
  METHODS
  Patients who underwent a repeat TEM for excision of rectal lesions, either for involved resection margins or for local recurrence, between the years 2000 and 2010, were identified. Rectal lesion characteristics were retrieved. Mean operative times, length of hospital stay, and intra- and postoperative complications were compared between primary and repeated procedures. The postoperative histopathology reports were reviewed, and the adequacy of resection was determined. All patients completed a questionnaire based on the Wexner score for anal sphincter function evaluation.
  
  
  RESULTS
  Fourteen patients (3 female, 11 male) underwent a repeat TEM operation during the study period. All procedures were completed endoscopically. Indications for repeated TEM were involved margins in 12 patients and recurrence of benign tumor in 2. Mean operative time, mean length of hospital stay, and rate of postoperative complications were similar for primary and repeated TEM procedures (62.5 ± 17 versus 55 ± 23 minutes, P=.181; 1.7 ± 1.3 versus 1.7 ± 1.12 days, P=.99; and 35.7% versus 21.4%, P=.66, respectively). The Wexner score was comparable at baseline and after the first and the second TEM procedures (1.5 ± 2.3, 1.5 ± 2.3, and 3.3 ± 3.1, respectively; P=.188). No cases of fecal incontinence following a repeat TEM were documented.
  
  
  CONCLUSIONS
  Repeated TEM is feasible and safe and may be appropriate for selected patients.
authors: Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Wisam
authors: W
authors: Khoury
authors: Hayim
authors: H
authors: Gilshtein
authors: Dmitri
authors: D
authors: Nordkin
authors: Yoram
authors: Y
authors: Kluger
authors: Simon-Daniel
authors: SD
authors: Duek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies