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European Journal of Gastroenterology &... Jul 2024Transanal minimally invasive surgery (TAMIS) is a surgical alternative to proctectomy in the management of complex rectal polyps and early rectal cancers. In 2016, our...
The effect of implementing a transanal minimally invasive surgical programme for the local excision of early rectal neoplasia on outcomes in a tertiary referral rectal cancer centre.
Transanal minimally invasive surgery (TAMIS) is a surgical alternative to proctectomy in the management of complex rectal polyps and early rectal cancers. In 2016, our institution introduced a TAMIS programme. The purpose of this study was to evaluate changes in practice and outcomes in our institution in the 3 years before and after the implementation of TAMIS. We conducted a retrospective analysis of a prospective database of patients who underwent proctectomy or TAMIS for the management of complex rectal polyps or early rectal cancers at our institution between 2013 and 2018. 96 patients were included in this study (41 proctectomy vs 55 TAMIS). A significant reduction was noted in the number of proctectomies performed in the 3 years after the implementation of TAMIS as compared to the 3 years before (13 vs 28) ( P < 0.001); 43% of patients ( n = 12) who underwent proctectomy in the period prior to implementation of TAMIS were American Society of Anaesthesiologists grade III, as compared to only 15% ( n = 2) of patients during the period following TAMIS implementation ( P = 0.02). TAMIS was associated with a significant reduction in length of inpatient stay ( P < 0.001). Oncological outcomes were comparable between groups (log rank P = 0.83). Our findings support TAMIS as a safe and effective alternative to radical resection. The availability of TAMIS has resulted in a significant reduction in the number of comorbid patients undergoing proctectomy at our institution. Consequently, we have observed a significant reduction in postoperative complications over this time period.
Topics: Humans; Rectal Neoplasms; Female; Male; Middle Aged; Aged; Retrospective Studies; Transanal Endoscopic Surgery; Proctectomy; Treatment Outcome; Length of Stay; Tertiary Care Centers; Postoperative Complications; Intestinal Polyps; Time Factors; Databases, Factual; Program Evaluation
PubMed: 38625823
DOI: 10.1097/MEG.0000000000002773 -
Diseases of the Colon and Rectum Jul 2024
Topics: Humans; Suture Techniques; Transanal Endoscopic Surgery; Intestinal Mucosa; Anal Canal; Endoscopic Mucosal Resection; Rectal Neoplasms
PubMed: 38603802
DOI: 10.1097/DCR.0000000000003225 -
Colorectal Disease : the Official... May 2024Restorative proctocolectomy with transabdominal ileal pouch-anal anastomosis (abd-IPAA) has become the standard surgical treatment for medically refractory ulcerative... (Meta-Analysis)
Meta-Analysis Review
AIM
Restorative proctocolectomy with transabdominal ileal pouch-anal anastomosis (abd-IPAA) has become the standard surgical treatment for medically refractory ulcerative colitis (UC). However, it requires a technically difficult distal anorectal dissection and anastomosis due to the bony confines of the deep pelvis. To address these challenges, the transanal IPAA approach (ta-IPAA) was developed. This novel approach may offer increased visibility and range of motion compared with abd-IPAA, although its postoperative benefits remain unclear. The aim of this work was to perform a systematic review and meta-analysis to compare and inform the frequency of postoperative outcomes between ta-IPAA and abd-IPAA for patients with UC.
METHOD
Several databases were searched from inception until May 2022 for studies reporting postoperative outcomes of patients undergoing ta-IPAA. Reviewers, working independently and in duplicate, evaluated studies for inclusion and graded the risk of bias. Odds ratios (OR), mean differences (MD) and prevalence ratio (PR) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects models. Sensitivity analysis was performed.
RESULTS
Ten retrospective studies comprising 284 patients with ta-IPAA were included. Total mesorectal excision was performed in 61.8% of cases and close rectal dissection in 27.9%. There was no difference in the odds of Clavien-Dindo (CD) I-II complications, CD III-IV and anastomotic leak (OR 0.96, 95% CI 0.27-3.40; OR 1.18, 95% CI 0.65-2.16; OR 1.37, 95% CI 0.58-3.23; respectively) between ta-IPAA and abd-IPAA. The ta-IPAA pooled CD I-II complication rate was 18% (95% CI 5%-35%) and for CD III-IV 10% (95% CI 5%-17%), and the anastomotic leak rate was 6% (95% CI 2%-10%). There were no deaths reported.
CONCLUSIONS
This meta-analysis compared the novel ta-IPAA procedure with abd-IPAA and found no difference in postoperative outcomes. While the need for randomized controlled trails and comparison of functional outcomes between both approaches remains, this evidence should assist colorectal surgeons to decide if ta-IPAA is a viable alternative.
Topics: Humans; Proctocolectomy, Restorative; Colitis, Ulcerative; Postoperative Complications; Treatment Outcome; Colonic Pouches; Anal Canal; Female; Male; Adult; Retrospective Studies; Middle Aged; Anastomosis, Surgical; Anastomotic Leak; Transanal Endoscopic Surgery; Inflammatory Bowel Diseases
PubMed: 38594838
DOI: 10.1111/codi.16977 -
Journal of Clinical Medicine Feb 2024Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and...
Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and management of anorectal pathologies. Performing the examination can be daunting not only for patients but also for junior doctors. There are associated risks with the procedure, such as pain, diagnostic failure, and perforation of the bowel. Simulation-based training is recognised as an important adjunct in clinical education. It allows students and doctors to practice skills and techniques at their own pace in a risk-free environment. These skills can then be transferred to and developed further in clinical practice. There is extensive research published regarding the role of simulation-based training in endoscopy, however, we identified no published study regarding simulation-based training in rigid sigmoidoscopy or proctoscopy. This study aims to establish the initial face, content, and construct validity of a tool-based visual anorectal examination advanced simulator model for proctoscopy and rigid sigmoidoscopy. This innovative, highly realistic simulated environment aims to enhance the training of healthcare professionals and improve the efficiency of detecting and diagnosing distal colorectal disease.
PubMed: 38592245
DOI: 10.3390/jcm13051423 -
Colorectal Disease : the Official... May 2024Transanal total mesorectal (taTME) excision is a method used to assist in the radical removal of the rectum. By adopting the concept of natural orifice surgery, it... (Meta-Analysis)
Meta-Analysis Review
AIM
Transanal total mesorectal (taTME) excision is a method used to assist in the radical removal of the rectum. By adopting the concept of natural orifice surgery, it offers potential benefits over conventional techniques. Early enthusiasm for this strategy led to its rapid and widespread adoption. The imposing of a local moratorium was precipitated by the discovery in Norway of an uncommon multifocal pattern of locoregional recurrence. The aim of this systematic review and meta-analysis was to determine the incidence of local recurrence after taTME for rectal cancer.
METHOD
Conforming to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines checklist, a systematic review and meta-analysis was conducted. This included case series and comparative studies between taTME and preferentially laparoscopic procedures published between 2010 and 2021.
RESULTS
There were a total of 1175 studies retrieved. After removal and screening for quality and relevance, the final analysis contained 40 studies. The local recurrence rate following taTME was 3.4% (95% CI 2.9%-3.9%, I = 0%) in 4987 patients with follow-up durations ranging from 0.7 to 5.5 years. Compared with laparoscopic TME, local recurrence was not statistically different for the taTME group (p = 0.076); however, it was less probable (OR = 0.51, 95% CI 0.24-1.09, I = 0%). Systemic recurrence and circumferential resection margin status were secondary outcomes; however, the differences were not statistically significant.
CONCLUSION
Our data suggest that the local recurrence for regular laparoscopic and transanal TME surgeries may be comparable, suggesting that taTME can be performed without influencing locoregional oncological outcomes in patients treated at specialized institutions and who have been cautiously selected.
Topics: Humans; Rectal Neoplasms; Transanal Endoscopic Surgery; Neoplasm Recurrence, Local; Proctectomy; Laparoscopy; Female; Treatment Outcome; Male; Middle Aged; Aged; Rectum; Incidence
PubMed: 38590019
DOI: 10.1111/codi.16982 -
The American Surgeon Apr 2024Idiopathic acute rectal necrosis (IARN) is a rare condition due to a robust rectal blood supply. This report describes an 83-year-old man presenting with septic shock...
Idiopathic acute rectal necrosis (IARN) is a rare condition due to a robust rectal blood supply. This report describes an 83-year-old man presenting with septic shock due to distal sigmoid and complete rectal necrosis with perforation. He underwent emergent exploratory laparotomy, sigmoid and proximal rectum resection, and end sigmoid colostomy creation with delayed distal rectal evaluation. Bedside proctoscopy revealed pale, viable-appearing distal rectal mucosa on postoperative day 3. The patient had a protracted, complicated hospital stay but required no further operative intervention. Subsequent colostomy reversal was done 8 months postoperatively, and the patient did well and has been discharged with normal gastrointestinal function. Our successful conservative operative management of IARN deviates from previously described management in the literature which is emergent abdominoperineal resection. This conservative surgical strategy appears to have contributed to the patient's positive outcomes, highlighting the importance of considering a similar approach for future IARN cases.
PubMed: 38569206
DOI: 10.1177/00031348241241690 -
Colorectal Disease : the Official... Jun 2024
Topics: Humans; Robotic Surgical Procedures; Rectal Neoplasms; Transanal Endoscopic Surgery; Adenocarcinoma in Situ; Male; Female; Adenocarcinoma
PubMed: 38561899
DOI: 10.1111/codi.16966 -
Techniques in Coloproctology Mar 2024
Topics: Humans; Robotic Surgical Procedures; Neuroendocrine Tumors; Rectal Neoplasms; Robotics; Transanal Endoscopic Surgery; Minimally Invasive Surgical Procedures; Anal Canal
PubMed: 38509210
DOI: 10.1007/s10151-024-02913-7 -
Diseases of the Colon and Rectum Jul 2024
Topics: Humans; Transanal Endoscopic Surgery; Rectal Neoplasms; Anal Canal
PubMed: 38479019
DOI: 10.1097/DCR.0000000000003200 -
JAMA Network Open Mar 2024
Topics: Humans; Proctoscopy; Early Detection of Cancer; Anus Neoplasms; Anal Canal
PubMed: 38427357
DOI: 10.1001/jamanetworkopen.2024.0019