Continence changes following transanal endoscopic microsurgery result from the impact on rectal capacity: clinical and functional evaluation before and after surgical treatment

Journal of Coloproctology - Tập 38 - Trang 227-232 - 2018
Carlos Ramon Silveira Mendes1,2,3,4, Sergio Eduardo Alonso Araujo5, Rodrigo Perez6, Ivan Cecconello6, Luiz Augusto Carneiro DÁlbuquerque6
1Hospital Santa Izabel, Serviço de Coloproctologia, São Paulo, SP, Brazil
2Sociedade Brasileira de Coloproctologia, Rio de Janeiro, RJ, Brazil
3Hospital Cardio Pulmonar, Serviço de Coloproctologia, Salvador, BA, Brazil
4Hospital Geral Roberto Santos, Serviço de Coloproctologia, Salvador, BA, Brazil
5Hospital Albert Einstein, São Paulo, SP, Brazil
6Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil

Tóm tắt

Abstract Introduction Described in 1983 and with a stable clinical application, the impact of Transanal Endoscopic Microsurgery on anorectal function remains unknown. The objectives of the present study were to evaluate the impact of Transanal Endoscopic Microsurgery on anorectal function according to clinical (Wexner score) and functional (anorectal manometry) evaluations before and after surgery. Method Prospectively, 23 consecutive patients with rectal lesions were operated using TEO® equipment (Karl Storz, Tuttlingen, Germany). For all patients, the value of Wexner score was obtained before and after surgery (7, 30 and 90 days) and anorectal electromanometry was performed before surgery, and also postoperatively (30 and 90 days). Results Fourteen patients were men. The mean age was 53.7 (24–81) years. The mean distance from the lesion to the pectineal line was 7 (2–15) cm. The histopathologic analysis revealed adenoma in 14 (61%); neuroendocrine tumor in 5 (21.7%); invasive carcinoma in 3 (13%); and hyperplastic polyp in 1 (4.3%) case. The mean duration of postoperative follow-up was 5 (3–7) months. Wexner score was significantly lower at 30 days compared to 7 days (Wilcoxon; p = 0.03). Rectal capacity was significantly lower 30 days after surgery and recovered at 90 days of surgery (ANOVA; p = 0.04). Conclusions After Transanal Endoscopic Microsurgery, a modest impact on anorectal function can be observed. The transient impairment results from loss of rectal capacity and not from impairment of the anal sphincters, being completely resolved 90 days after surgery.

Tài liệu tham khảo

Buess, 1983, Transanal endoscopic surgery of the rectum – testing a new method in animal experiments, Leber Magen Darm, 13, 7 Buess, 1985, Endoscopic surgery in the rectum, Endoscopy, 17, 31, 10.1055/s-2007-1018451 Buess, 1989, Microscopic endoscopic tumor surgery. What is possible?, Langenbecks Arch Chir Suppl II Verhandlungen Dtsch Ges Chir Dtsch Ges Chir Kongr, 553 Buess, 1988, Technique of transanal endoscopic microsurgery, Surg Endosc, 2, 71, 10.1007/BF00704356 Atallah, 2010, Transanal minimally invasive surgery: a giant leap forward, Surg Endosc, 24, 2200, 10.1007/s00464-010-0927-z Atallah, 2011, Robotic transanal minimally invasive surgery in a cadaveric model, Tech Coloproctol, 15, 461, 10.1007/s10151-011-0762-9 Dafnis, 2004, Transanal endoscopic microsurgery: clinical and functional results, Colorectal Dis Off J Assoc Coloproctol G B Irel, 6, 336 Herman, 2001, Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery, Int J Colorectal Dis, 16, 370, 10.1007/s003840100325 Allaix, 2011, Long-term functional results and quality of life after transanal endoscopic microsurgery, Br J Surg, 98, 1635, 10.1002/bjs.7584 Kreis, 1996, Functional results after transanal endoscopic microsurgery, Dis Colon Rectum, 39, 1116, 10.1007/BF02081411 Banerjee, 1996, Prospective study of the proctographic and functional consequences of transanal endoscopic microsurgery, Br J Surg, 83, 211, 10.1002/bjs.1800830217 Kennedy, 2002, Transanal endoscopic microsurgery excision: is anorectal function compromised?, Dis Colon Rectum, 45, 601, 10.1007/s10350-004-6252-7 Jorge, 1993, Etiology and management of fecal incontinence, Dis Colon Rectum, 36, 77, 10.1007/BF02050307 Gracia Solanas, 2006, A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery, Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig, 98, 234 Doornebosch, 2008, Impact of transanal endoscopic microsurgery on functional outcome and quality of life, Int J Colorectal Dis, 23, 709, 10.1007/s00384-008-0442-z Cataldo, 2005, Transanal endoscopic microsurgery: a prospective evaluation of functional results, Dis Colon Rectum, 48, 1366, 10.1007/s10350-005-0031-y Valsdottir, 2014, Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions, Surg Endosc, 28, 193, 10.1007/s00464-013-3155-5 Mora López, 2015, Study of anorectal function after transanal endoscopic surgery, Int J Surg, 13, 142, 10.1016/j.ijsu.2014.11.021 Planting, 2013, Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life, Can J Surg, 56, 243, 10.1503/cjs.028411 Zhang, 2012, Anorectal functional outcome after repeated transanal endoscopic microsurgery, World J Gastroenterol, 18, 5807, 10.3748/wjg.v18.i40.5807 Jin, 2010, Anorectal functional results after transanal endoscopic microsurgery in benign and early malignant tumors, World J Surg, 34, 1128, 10.1007/s00268-010-0475-7 Speakman, 1991, Sphincter injury after anal dilatation demonstrated by anal endosonography, Br J Surg, 78, 1429, 10.1002/bjs.1800781206 MacDonald, 1992, Manual dilatation of the anus, Br J Surg, 79, 1381, 10.1002/bjs.1800791248 Van Tets, 1997, Influence of Parks’ anal retractor on anal sphincter pressures, Dis Colon Rectum, 40, 1042, 10.1007/BF02050926 Au-Yong, 2004, Randomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy; a three and a half year follow up, Colorectal Dis, 6, 37, 10.1111/j.1463-1318.2004.00496.x
Thông tin
Thông tin xuất bản

Journal of Coloproctology

Tập 38

227-232

Thông tin tác giả