TAMIS sin cierre de la brecha quirúrgica

Diego Naiderman

doi:10.46768/racp.v32i01.19

Diego Naiderman maac

DOI: https://doi.org/10.46768/racp.v32i01.19

Keywords: TAMIS, transanal surgery, closure, surgical defect, complications.

Abstract

Background: Transanal Minimally Invasive Surgery (TAMIS) is a technique that is especially useful in extraperitoneal rectum injuries difficult to be anteriorly approached.

Currently, the closure of the rectal defect below peritoneal reflection is still controversial. The endoluminal suture is one of the most challenging aspects of the procedure and the literature is discordant regarding the closure of the defect. Our goal is to carry out a descriptive study of a consecutive series of patients with extraperitoneal rectum injuries, who undergone TAMIS surgery, leaving the surgical defect open.

Design: a prospective longitudinal descriptive study.

Material and Method: Between August 2013 and July 2019, all patients with extra peritoneal rectum lesions, operated using the TAMIS technique, were consecutively included. The presented lesions were: benign lesions ≥ 3 centimeters difficult to endoscopic resolution, neuroendocrine tumors ≥ of 2 cm, T1N0 adenocarcinomas without histological signs for poor prognosis, T2N0 adenocarcinomas with high surgical risk or patients reluctant to radical surgery and others with doubtful about a complete remission after neoadjuvant therapy.

All the procedures were performed by the same surgeon and in all of them, the surgical defect was left open.

Results: In a 6-year period, 35 patients were treated using TAMIS technique, with an average age of 61 years ± 12. The average size of the lesions was 3.68 ± 2.1 cm (0.7-9 cm) and the distance from the anal margin to the distal end of the lesion was 5.7 ± 1.48 cm (3 to 8.5 cm). The operative time was 39.2 ± 20.5 min and the hospitalization time was 33 ± 28.2 hours.

The pathological anatomy of the resected lesions was: 15 adenomas, 3 carcinoid tumors and 17 adenocarcinomas. 1 ypT0, 4 carcinomas in situ, 4 T1 tumors and 8 T2 tumors. In all cases, the rectal defect was left open, with a minimum post-operative follow-up of 9 months.

There were no deaths and the overall morbidity was 14.2% (5 patients). Two patients were admitted for pain treatment (Clavien-Dindo II) and 3 patients (8.5%) were assisted for postoperative bleeding, out of which only 1 (2.8%) required reoperation (Clavien-Dindo III). There were no infectious complications, postsurgical rectum stenosis, or perforations into the abdominal cavity.

Conclusion: Our results allow us to describe TAMIS technique, leaving the surgical defect open, as a technique with good results, high feasibility and low complication rate.