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Surg Endosc ; 29(12): 3454-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25801107


BACKGROUND: Transanal endoscopic microsurgery (TEM) for the excision of rectal tumor is mostly performed as an inpatient procedure. The aim of this study was to assess the feasibility and safety of TEM resection as an outpatient procedure in selected patients. POPULATION: All first 178 consecutive patients who underwent resection of a rectal tumor using TEM in our institution from April 2011 to September 2013 were included. METHOD: Standardized retrospective chart review was performed. Primary outcome was 30-day mortality and morbidity. Secondary outcomes included unplanned admission and readmission rates, operative and pathologic data. RESULTS: Of the 175 patients who underwent only TEM, 80% (140/175) were discharged the same day of surgery. There was no mortality. Morbidity rate was 31.4%. Ninety-one percent of 154 patients planned as outpatients were discharged the same day. The most common reason for unplanned admission was urinary retention (7/14; 50%). Twelve patients discharged the day of the procedure were readmitted at 30 days. Median operative time was 60 min (10-256 min). All lesions were removed with grossly negative margins with 15 positive microscopic margins on final pathology. A total of 124 adenomatous polyps and 37 malignant lesions were excised. Mean tumor diameter after fixation was 5.0 cm (range 0.5-11 cm). CONCLUSION: Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe in selected patients. The main reason for unplanned admission was urinary retention in our series.

Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Neoplasias Retais/cirurgia , Microcirurgia Endoscópica Transanal/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Neoplasias Retais/mortalidade , Estudos Retrospectivos
Can J Surg ; 57(6): 405-11, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25421083


BACKGROUND: Turnbull-Cutait abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) was first described in 1961. Studies have described its use for challenging colorectal conditions. We reviewed our experience with Turnbull-Cutait DCA as a salvage procedure for complex failure of colorectal anastomosis. METHODS: We performed a retrospective cohort study from October 2010 to September 2011, with analysis of postoperative morbidity and mortality. RESULTS: Seven DCAs were performed for anastomotic complications (3 chronic leaks, 2 rectovaginal fistulas, 1 colovesical fistula, 1 colonic ischemia) following surgery for rectal cancer. Six patients had a diverting ileostomy constructed as part of previous treatment for anastomotic complications before the salvage procedure. No anastomotic leaks were observed. All procedures but 1 were completed successfully. One patient who underwent DCA subsequently required an abdominoperineal resection and a permanent colostomy for postoperative extensive colonic ischemia. No 30-day mortality occurred. CONCLUSION: Salvage Turnbull-Cutait DCA appears to be a safe procedure and could be offered to patients with complex anastomotic complications. This procedure could be added to the surgeon's armamentarium as an alternative to the creation of a permanent stoma.

Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/cirurgia , Reto/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Enterostomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/métodos , Terapia de Salvação/métodos