Skip to main content
SpringerLink
Log in

Peritoneal perforation is less a complication than an expected event during transanal endoscopic microsurgery: experience from 194 consecutive cases

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Indications for transanal endoscopic microsurgery (TEM) have been extended to technically challenging tumors, which may be associated with an increased risk of peritoneal perforation (PP). The aim of the present study was to investigate the occurrence, management and outcome of PP in patients having TEM.

Methods

All the patients who had TEM for rectal adenoma or adenocarcinoma in our unit were included. Patients in whom PP occurred (Group A) were compared to those without PP (Group B).

Results

From 2007 to 2015, 194 TEM (116 men, median age 66 [range 21–100] years) were divided into Groups A (n = 28, 14%) and B (n = 166). The latter group included four patients, in whom a laparoscopy did not confirm suspicion of PP made during TEM. In 2 of 28 patients (7%), the diagnosis of PP was made postoperatively during reoperation for peritonitis. For the 26 other patients (93%), routine exploratory laparoscopy was performed with suture of the peritoneal defect on the pouch of Douglas in 24 cases and a rectal suture alone in 2 cases. Independent predictive factors for PP were: distance from the anal verge >10 cm (OR = 3.6), circumferential tumor (OR = 3.0) and anterior location (OR = 2.7). Hospital stay was significantly longer in Group A (7.5 [3–31] days) than in Group B (4 [1–38] days; p < 0.0001), whereas there was no significant difference regarding postoperative morbidity and recurrence rate.

Conclusions

Our results suggested that PP is not a very rare event during TEM, especially in anterior, circumferential and/or high rectal tumors. Laparoscopic treatment of PP is feasible and safe. The occurrence of PP is not associated with poor oncologic results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Demartines N, Von Flüe MO, Harder FH (2001) Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 25:870–875

    Article  CAS  PubMed  Google Scholar 

  2. Darwood RJ, Wheeler JMD, Borley NR (2008) Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions. Br J Surg 95:915–918

    Article  CAS  PubMed  Google Scholar 

  3. Christoforidis D, Cho H-M, Dixon MR, Mellgren AF, Madoff RD, Finne CO (2009) Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249:776–782

    Article  PubMed  Google Scholar 

  4. Peng J, Chen W, Sheng W, Xu Y, Cai G, Huang D et al (2011) Oncological outcome of T1 rectal cancer undergoing standard resection and local excision. Colorectal Dis 13:e14–e19

    Article  CAS  PubMed  Google Scholar 

  5. Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Transanal endoscopic microsurgery. Leber Magen Darm 15:271–279

    CAS  PubMed  Google Scholar 

  6. Moore JS, Cataldo PA, Osler T, Hyman NH (2008) Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 51:1026–1031

    Article  PubMed  Google Scholar 

  7. Guerrieri M, Baldarelli M, De Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449

    Article  PubMed  Google Scholar 

  8. Langer C, Liersch T, Süss M, Siemer A, Markus P, Ghadimi BM et al (2003) Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 18:222–229

    CAS  PubMed  Google Scholar 

  9. Saget A, Maggiori L, Petrucciani N, Petruciani N, Ferron M, Panis Y (2015) Is there a limit to transanal endoscopic surgery? a comparative study between standard and technically challenging indications among 168 consecutive patients. Colorectal Dis 17:O155–O160

    Article  CAS  PubMed  Google Scholar 

  10. Khoury R, Duek SD, Issa N, Khoury W (2016) Transanal endoscopic microsurgery for large benign rectal tumors; where are the limits? Int J Surg 29:128–131

    Article  PubMed  Google Scholar 

  11. Gavagan JA, Whiteford MH, Swanstrom LL (2004) Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 187:630–634

    Article  PubMed  Google Scholar 

  12. Ramwell A, Evans J, Bignell M, Mathias J, Simson J (2009) The creation of a peritoneal defect in transanal endoscopic microsurgery does not increase complications. Colorectal Dis 11:964–966

    Article  CAS  PubMed  Google Scholar 

  13. Baatrup G, Borschitz T, Cunningham C, Qvist N (2009) Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise. Surg Endosc 23:2680–2683

    Article  PubMed  Google Scholar 

  14. Morino M, Allaix ME, Famiglietti F, Caldart M, Arezzo A (2013) Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery? Surg Endosc 27:181–188

    Article  PubMed  Google Scholar 

  15. Marks JH, Frenkel JL, Greenleaf CE, D’Andrea AP (2014) Transanal endoscopic microsurgery with entrance into the peritoneal cavity: is it safe? Dis Colon Rectum 57:1176–1182

    Article  PubMed  Google Scholar 

  16. Eyvazzadeh DJ, Lee JT, Madoff RD, Mellgren AF, Finne CO (2014) Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis. Dis Colon Rectum 57:438–441

    Article  PubMed  Google Scholar 

  17. Maggiori L, Panis Y (2012) Transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Acta Chir Iugosl 59:87–90

    Article  PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  19. Morino M, Risio M, Bach S, Beets-Tan R, Bujko K, Panis Y et al (2015) Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc 29:755–773

    Article  PubMed  Google Scholar 

  20. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  21. Molina G, Bordeianou L, Shellito P, Sylla P (2016) Transanal endoscopic resection with peritoneal entry: a word of caution. Surg Endosc 30:1816–1825

    Article  PubMed  Google Scholar 

  22. Mege D, Bridoux V, Maggiori L, Tuech JJ, Panis Y (2016) What is the best tool for transanal endoscopic microsurgery (TEM)? a case-matched study in 74 patients comparing a standard platform and a disposable material. Int J Colorectal Dis. doi:10.0007/s00384-0162733-0

    PubMed  Google Scholar 

  23. Allaix ME, Arezzo A, Caldart M, Festa F, Morino M (2009) Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum 52:1831–1836

    Article  PubMed  Google Scholar 

  24. De Graaf EJR, Doornebosch PG, Tetteroo GWM, Geldof H, Hop WCJ (2009) Transanal endoscopic microsurgery is feasible for adenomas throughout the entire rectum: a prospective study. Dis Colon Rectum 52:1107–1113

    Article  PubMed  Google Scholar 

  25. Issa N, Fenig Y, Yasin M, Schmilovitz-Weiss H, Khoury W, Powsner E (2016) Laparoscopy following peritoneal entry during transanal endoscopic microsurgery may increase the safety and maximize the benefits of the transanal excision. Tech Coloproctol 20:221–226

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Paris University, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    D. Mege, N. Petrucciani, L. Maggiori & Y. Panis

Authors
  1. D. Mege
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Petrucciani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Maggiori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Panis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Panis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted according to the ethical standards of the Committee on Human Experimentation of our institution.

Informed consent

Informed consent was obtained from all the individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mege, D., Petrucciani, N., Maggiori, L. et al. Peritoneal perforation is less a complication than an expected event during transanal endoscopic microsurgery: experience from 194 consecutive cases. Tech Coloproctol 21, 729–736 (2017). https://doi.org/10.1007/s10151-017-1676-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-017-1676-y

Keywords

Search

Navigation