Transanal endoscopic microsurgery (TEM) facilitates excision of lesions throughout the entire rectum. Depending upon rectal location, full-thickness rectal wall excision can result in increased potential for complications. The proximal rectum, particularly anteriorly, is located within the peritoneal cavity, and wound dehiscence can lead to intraperitoneal sepsis. In women, the vagina is immediately anterior to the distal one third of the anterior rectum, putting patients at increased risk for anovaginal fistula following full-thickness resection. In the very distal rectum, just above the dentate line sphincter musculature is at risk, and full-thickness wounds heal poorly. In all these circumstances partial-thickness, or submucosal, excision is associated with lower morbidity. If the pathologic finding is appropriate (i.e., benign disease) partial-thickness rectal wall excision is an excellent alternative in these situations.
Partial-thickness excision is...
KeywordsRectal Wall Transanal Endoscopic Microsurgery Excision Wound Occult Malignancy Submucosal Plane
- 2.Bach S, Lane L, Merrie A, Mortensen NJMcC. Stage 1 Rectal Cancer: transanal endoscopic microsurgery or radical resection. Colorectal Dis. 2006; 8:(Suppl 2) 19.Google Scholar
- 7.Steele RJ, Hershman, MJ, Mortensen NJMcC, Armitage NC, Scholefield JH. Transanal endoscopic microsurgery – initial experience from three centres in the United Kingdom. Br J Surg. 1996; 83(2):207–10.Google Scholar
- 9.Whitehouse PA, Tilney HS, Armitage JN, Simson JN. Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas. Colorectal Dis. 2006; (9):795–9.Google Scholar