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Short-term clinical and functional results of rectal wall suture defect after transanal endoscopic microsurgery—a prospective cohort study

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Abstract

Purpose

Our goal was to assess the outcomes of rectal wall suture during the early and late periods after transanal endoscopic microsurgery (TEM) and long-term bowel function.

Methods

Patients who underwent TEM for rectal neoplasms from May 2017 to March 2021 were prospectively included. A total of 70 patients were enrolled. Seven to 10 days after TEM, clinical data were recorded, and digital rectal examination and rigid proctoscopy were performed. After at least 6 months, bowel function was evaluated using low anterior resection syndrome (LARS) and Wexner questionnaires.

Results

Forty-five men with an average age of 67 ± 10.1 (40–85) were included. TEM sutures were recorded as intact in 48/70 (68%) and as dehiscent in 22/70 (32%). It did not have any significant clinical manifestation and was not related with longer postoperative stay or incidence of postoperative complications. Eight of 22 (36.4%) patients with suture dehiscence had per rectal bleeding or febrile temperature without any need for intervention or treatment. The only risk factor for wound dehiscence was a posteriorly located defect. In late postoperative period, there was no difference between groups in LARS or Wexner questionnaire (p value 0.72 and 0.85, respectively).

Conclusions

Our study suggests that 1/3 of the patients’ rectal wall defect after TEM will undergo dehiscence in early postoperative period and will not transfer to clinically significant manifestation (without a need of hospitalization or prolonging it). In late postoperative period, there is no difference in bowel function.

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Acknowledgements

This research was funded by the European Social Fund under the No 09.3.3-LMT-K-712 “Development of Competences of Scientists, other Researchers and Students through Practical Research Activities” measure.

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Authors and Affiliations

  1. Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu Str, 08406, Vilnius, Lithuania

    Audrius Dulskas

  2. Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, LT – 08406, Vilnius, Lithuania

    Audrius Dulskas, Vidas Petrauskas, Povilas Kavaliauskas, Virginijus Sapoka & Narimantas E. Samalavicius

  3. Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, 92288, Klaipeda, Lithuania

    Narimantas E. Samalavicius

Authors
  1. Audrius Dulskas
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  2. Vidas Petrauskas
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  4. Virginijus Sapoka
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  5. Narimantas E. Samalavicius
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Contributions

NES, VP, PK, and AD contributed to this work, satisfying the following four criteria of the guidelines of the International Committee of Medical Journal Editors (ICMJE): substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Audrius Dulskas.

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Informed consent

Informed consent was obtained from the patient.

Conflict of interest

The authors declare no competing interest.

Research involving human participants and/or animals

All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies using animals.

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Part of the material was presented as an e-poster at ASCRS conference in Cleveland, USA, June 4, 2019, and as a poster at ESCP conference in Vienna, Austria, September 25, 2019.

What does this paper add to the literature?

Thirty-two percent of rectal wounds after suturing using TEM will dehisce without any clinical manifestation. There is no difference in bowel function in long postoperative period. This might show that leaving the wound open is safe and reasonable.

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Cite this article

Dulskas, A., Petrauskas, V., Kavaliauskas, P. et al. Short-term clinical and functional results of rectal wall suture defect after transanal endoscopic microsurgery—a prospective cohort study. Langenbecks Arch Surg 407, 2035–2040 (2022). https://doi.org/10.1007/s00423-022-02476-x

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  • DOI: https://doi.org/10.1007/s00423-022-02476-x

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