title: Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis.
abstract: BACKGROUND
  Transanal endoscopic microsurgery has gained increasing popularity as a treatment alternative for early stage rectal neoplasms. With continued advances in technique and experience, more proximal rectal tumors are being surgically managed by using transanal endoscopic microsurgery with an intraperitoneal anastomosis.
  
  
  OBJECTIVE
  The purpose of this study was to review the outcomes of patients who have undergone intraperitoneal anastomosis with the use of the transanal endoscopic microsurgery technique.
  
  
  METHODS
  A prospective, single-surgeon database documented 445 consecutive patients undergoing transanal endoscopic microsurgery from October 1, 1996 through January 1, 2012. We retrospectively reviewed information from all patients who underwent transanal endoscopic microsurgery with an intraperitoneal anastomosis in this prospective database.
  
  
  METHODS
  All procedures took place in an inpatient hospital setting.
  
  
  METHODS
  All patients satisfied workup criteria to undergo surgery for rectal neoplasm.
  
  
  METHODS
  All patients underwent transanal endoscopic microsurgery for rectal neoplasm.
  
  
  METHODS
  Size and pathology of lesion, length of procedure, hospital stay, estimated blood loss, margin status, and complications were the outcomes measured.
  
  
  RESULTS
  Twenty-eight patients who underwent transanal endoscopic microsurgery had definitively documented intraperitoneal entry and anastomosis. Median follow-up was 12 months (range, 0.5-111 months). There were no operative mortalities. Procedure-related complications included urinary retention (11%), fever (11%), and fecal seepage (4%). Four patients (14%) had positive margins on final pathology. One patient (3%) required abdominal exploration for an anastomotic leak but did not require diversion.
  
  
  CONCLUSIONS
  Although this study analyzes prospectively collected data, it is nonetheless a retrospective analysis that can introduce bias. Because this is a single-center study with a relatively homogenous population, the results may not be generalizable. Our sample size may also be underpowered to detect clinically significant outcomes.
  
  
  CONCLUSIONS
  Transanal endoscopic microsurgery with intraperitoneal anastomosis can be safely performed without fecal diversion by experienced surgeons.
authors.affiliation: 1Colon and Rectal Surgery, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania 2Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota 3Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Eyvazzadeh
authors.forename: Janet T
authors.initials: JT
authors.lastname: Lee
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: Anders F
authors.initials: AF
authors.lastname: Mellgren
authors.forename: Charles O
authors.initials: CO
authors.lastname: Finne
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome