Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1370_Библиотеки_им_академика_М_И_Перельмана

COMPLICATIONS OF TRANSANAL AND TEM

The complication rates of TEM are significantly lower than traditional radical surgery. In a review of 12 studies performed by Casadesus in 2006, the morbidity of 893 patients was evaluated. (22) Complications were noted in 15.9% of the patients overall, more than half of which were related to urinary retention or tran­sient incontinence. These complications are typically seen early in the postoperative period and very few patients required interven­tion other than catheterization for resolution. The rate of bleed­ing was also extremely low, seen in approximately 3% of cases of TEM and rarely required either transfusion or operative interven­tion. Postoperative fever, pelvic pain, and myocardial infarction have been reported but are also extremely rare. Throughout the literature, there is only one reported case of death directly follow­ing TEM. This patient died from septic shock 4 weeks following TEM excision of a rectal adenoma secondary to a retroperitoneal phlegmon.(23) With TEM surgery, there is always the possibility of rectal perforation, particularly with anteriorly located lesions. Major complications of perforation, wound dehiscence, and fistula formation have all been reported. Perforation with intraab­dominal contamination is a rare complication and is clearly both operator and patient dependent and may require conversion to an open operation for control. This can be especially problematic in the older female who may have undergone prior hysterectomy. Perforation in these patients may yield fistula formation. Wound dehiscence has been described but is also a rare, but potential complication. In a large review of 334 patients, a major complica­tion rate of 5.5% was cited. This included both intraperitoneal sepsis (n=3) and rectovaginal fistula (n=3).(24)