PMID- 19175654
OWN - NLM
STAT- MEDLINE
DCOM- 20100202
LR  - 20091016
IS  - 1463-1318 (Electronic)
IS  - 1462-8910 (Linking)
VI  - 11
IP  - 9
DP  - 2009 Nov
TI  - The creation of a peritoneal defect in transanal endoscopic microsurgery does not 
      increase complications.
PG  - 964-6
LID - 10.1111/j.1463-1318.2008.01719.x [doi]
AB  - INTRODUCTION: During Transanal Endoscopic Microsurgical (TEMS) full-thickness 
      excision of a rectal lesion above the peritoneal reflection, entrance to the 
      peritoneal cavity is inevitable. This has been regarded as a complication that 
      requires conversion to an open procedure. We describe our experience of full 
      thickness intraperitoneal excision of rectal lesions where the peritoneal defect 
      was sutured endoscopically. METHOD: Data were collected prospectively on 15 
      patients in whom a peritoneal defect was created intraoperatively during TEMS 
      excision of a rectal lesion. When a defect was recognized, it was closed by 
      endoscopic suture. If there was any doubt regarding security of the closure, a 
      defunctioning loop stoma was fashioned. RESULTS: Between November 1998 and 
      January 2008, a total of 257 patients underwent TEMS during which a peritoneal 
      defect was created in 15 patients. Six patients had a defunctioning stoma formed 
      at the time of TEMS. No patient was defunctioned postoperatively and there were 
      no deaths. The mean hospital stay was 8 days (range 3 to 19 days). A contrast 
      enema showed sub-clinical leaks in two patients for which no treatment was 
      required. No patient developed pelvic or peritoneal sepsis, but one patient had 
      to return to theatre for postoperative bleeding when a single bleeding vessel was 
      coagulated. CONCLUSION: Full thickness excision of lesions in the intraperitoneal 
      rectum with endoscopic suture of the defect is a safe procedure. Lesions in the 
      upper rectum should not be excluded from TEMS excision because of the chance of 
      peritoneal breach.
FAU - Ramwell, A
AU  - Ramwell A
AD  - SpR General Surgery, St. Richard's Hospital, Chichester, West Sussex, UK.
FAU - Evans, J
AU  - Evans J
FAU - Bignell, M
AU  - Bignell M
FAU - Mathias, J
AU  - Mathias J
FAU - Simson, J
AU  - Simson J
LA  - eng
PT  - Journal Article
DEP - 20081021
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Humans
MH  - *Medical Errors
MH  - Microsurgery/*adverse effects
MH  - Middle Aged
MH  - Peritoneum/*injuries
MH  - Proctoscopy/*adverse effects
MH  - Rectum/*surgery
MH  - Surgical Stomas
MH  - *Suture Techniques
EDAT- 2009/01/30 09:00
MHDA- 2010/02/03 06:00
CRDT- 2009/01/30 09:00
PHST- 2009/01/30 09:00 [entrez]
PHST- 2009/01/30 09:00 [pubmed]
PHST- 2010/02/03 06:00 [medline]
AID - CDI1719 [pii]
AID - 10.1111/j.1463-1318.2008.01719.x [doi]
PST - ppublish
SO  - Colorectal Dis. 2009 Nov;11(9):964-6. doi: 10.1111/j.1463-1318.2008.01719.x. Epub 
      2008 Oct 21.