Minerva Chirurgica 2021 Jan 12

DOI: 10.23736/S0026-4733.20.08405-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Management of intra- and post-operative complications during TEM/TAMIS procedures. A systematic review

Xavier SERRA-ARACIL ✉, Jesus BADIA-CLOSA, Anna PALLISERA-LLOVERAS, Laura MORA-LOPEZ, Sheila SERRA-PLA, Albert GARCIA-NALDA, Salvador NAVARRO-SOTO

Colorectal Unit, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain

INTRODUCTION: Transanal endoscopic microsurgery (TEM) is a safe procedure and the rates of intra- and post-operative complications are low. The information in the literature on the management of these complications is limited, and so their importance may be either under- or overestimated (which may in turn lead to under- or overtreatment). The present article reviews the most relevant series of TEM procedures and their complications and describes various approaches to their management.
EVIDENCE ACQUISITION: A systematic review of the literature, including TEM series of more than 150 cases each. We analyzed the population characteristics, surgical variables and intraoperative and postoperative complications.
EVIDENCE GATHERING: A total of 1043 records were found. After review, 1031 were excluded. The review therefore includes 12 independent cohorts of TEM procedures with a total of 4395 patients. The rate of perforation into the peritoneal cavity was 5.1%, and conversion to abdominal approach was required in 0.8% of cases. The most frequent complications were acute urinary retention (AUR, 4.9%) and rectal bleeding (2.2%). Less common complications included abscesses (0.99%) and rectovaginal fistula (0.62%). Mortality rates were low, with a mean value of 0.29%.
CONCLUSIONS: Awareness and knowledge of TEM complications and their management can play an important role in their treatment and patient safety. Here, we present a review of the most important TEM series and their complication rates and describe various approaches to their management.

KEY WORDS: Transanal endoscopic microsurgery; TEM; TEO; Minimally invasive surgery; Morbidity; Morbidity management