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Clin Colon Rectal Surg 2022; 35(02): 129-134
DOI: 10.1055/s-0041-1742113
Review Article

Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal

Xavier Serra-Aracil 
1   Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
,
Victoria Lucas-Guerrero
1   Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
,
Laura Mora-López
1   Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract

Transanal endoscopic microsurgery (TEM) allows the local excision of rectal tumors and achieves lower morbidity and mortality rates than total mesorectal excision. TEM can treat lesions up to 18 to 20 cm from the anal verge, obtaining good oncological results in T1 stage cancers and preserving sphincter function. TEM is technically demanding. Large lesions (>5 cm), those with high risk of perforation into the peritoneal cavity, those in the upper rectum or the rectosigmoid junction, and those in the anal canal are specially challenging. Primary suture after peritoneal perforation during TEM is safe and it does not necessarily require the creation of a protective stoma. We recommend closing the wall defect in all cases to avoid the risk of inadvertent perforation. It is important to identify these complex lesions promptly to transfer them to reference centers. This article summarizes complex procedures in TEM.

Keywords

TEM - TEO - TAMIS - complex lesions by TEM

Authors' Contribution

All authors contributed on the basis of the criteria established by the International Committee of Medical Journal Editors.




Publikationsverlauf

Artikel online veröffentlicht:
28. Februar 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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