title: Study of anorectal function after transanal endoscopic surgery.
abstract: OBJECTIVE
  To evaluate the impact of Transanal Endoscopic Microsurgery (TEM) on anorectal function, using clinical and manometric assessments. To identify subgroups likely to develop incontinence after TEM, by stratifying the sample.
  
  
  METHODS
  Descriptive, prospective study. Between December 2004 and May 2011, 222 patients were operated on at our hospital, of whom 21 were excluded from the study. Patients underwent anal manometry and answered a clinical incontinence questionnaire (the Wexner scale) prior to surgery, one month post-surgery, and then at four months post-surgery.
  
  
  RESULTS
  There were no statistically significant differences between preoperative Wexner questionnaire scores and values at one month and four months post-surgery. Preoperative baseline pressure (BP) values were 64 mmHg±26.18, falling to 44.26 mmHg±20.11 at one month and to 48.86 mmHg±21.14 at four months. Voluntary Contraction Pressure (VCP) reached preoperative values of 200.49 mmHg±88.85, falling to 169.5 mmHg±84.95 and to 173.6±79 at four months. The differences in BP and VCP were statistically significant. The sample was stratified in order to identify subsets susceptible to incontinence after surgery, but no at-risk subgroups were found. Multivariate analysis did not detect any predictors of incontinence.
  
  
  CONCLUSIONS
  The sustained, controlled anal dilatation produced with TEM caused statistically significant decreases in VCP and BP one month and four months after surgery. However, the Wexner questionnaire scores did not show any association with clinical incontinence. No predictors of postoperative incontinence were observed. We conclude that TEM is a safe technique and does not affect continence.
authors.affiliation: Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain. Electronic address: Lmora@tauli.cat.
authors.forename: L
authors.initials: L
authors.lastname: Mora López
authors.affiliation: Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Serra Aracil
authors.affiliation: Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Hermoso Bosch
authors.affiliation: Gastroenterology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Rebasa
authors.affiliation: Gastroenterology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Navarro Soto
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011312:Pressure; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Continence; Transanal endoscopic surgery