Annals of Coloproctology

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Original Article

Minimally invasive surgery

Minimally invasive transanal excision for rectal tumors: technical feasibility compared to conventional approach: Ji Yeon Mun, Gyu Sung Geong, Nina Yoo, Hyung Jin Kim, Hyeon-Min Cho, Bong-Hyeon Kye; Ann Coloproctol. 2025;41(2):162-168. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00864.0123

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited.
Methods
Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups.
Results
There were no significant differences observed in patient’s demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation.
Conclusion
The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.

Citations

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Minimally invasive transanal excision over conventional transanal excision: pursuing the perfect removal of early rectal cancer
HyungJoo Baik
Annals of Coloproctology.2025; 41(2): 105. CrossRef

Review

Colorectal cancer

Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision: Daichi Kitaguchi, Masaaki Ito; Ann Coloproctol. 2024;40(4):375-383. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00178.0025

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Abstract PDF

This study aimed to review the historical transition of rectal cancer surgery and recent evidence regarding transanal total mesorectal excision (TaTME). Additionally, it outlined the anatomical landmarks and technical considerations essential for successful TaTME. Anatomical studies and surgical techniques were analyzed to identify key landmarks and procedural steps crucial for TaTME. TaTME offers improved visibility and maneuverability even in the deep and narrow pelvis and is expected to contribute to tumor radical cure rates. By securing the circumferential resection margin and distal margin while preserving pelvic autonomic nerve function, TaTME holds promise for maintaining postoperative urinary and sexual functions. Key anatomical landmarks include the endopelvic fascia posteriorly, the S4-pelvic splanchnic nerve laterally, and the prostate or posterior vaginal wall anteriorly. Selecting the appropriate dissection layer based on tumor depth and ensuring precise incision of the tendinous arch of the pelvic fascia contributes to successful TaTME outcomes. TaTME represents a significant advancement in rectal cancer surgery, offering improved outcomes through meticulous attention to anatomical detail and precise dissection techniques. Understanding the historical context of rectal cancer surgery alongside recent evidence on TaTME is essential for optimizing patient outcomes and expanding the safe implementation of this innovative approach.

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From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Original Article

Translational/basic research

Exfoliate cancer cell analysis in rectal cancer surgery: comparison of laparoscopic and transanal total mesorectal excision, a pilot study: Kiho You, Jung-Ah Hwang, Dae Kyung Sohn, Dong Woon Lee, Sung Sil Park, Kyung Su Han, Chang Won Hong, Bun Kim, Byung Chang Kim, Sung Chan Park, Jae Hwan Oh; Ann Coloproctol. 2023;39(6):502-512. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00479.0068

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Minimally invasive surgery (MIS) is currently the standard treatment for rectal cancer. However, its limitations include complications and incomplete total mesorectal resection (TME) due to anatomical features and technical difficulties. Transanal TME (TaTME) has been practiced since 2010 to improve this, but there is a risk of local recurrence and intra-abdominal contamination. We aimed to analyze samples obtained through lavage to compare laparoscopic TME (LapTME) and TaTME.
Methods
From June 2020 to January 2021, 20 patients with rectal cancer undergoing MIS were consecutively and prospectively recruited. Samples were collected at the start of surgery, immediately after TME, and after irrigation. The samples were analyzed for carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) through a quantitative real-time polymerase chain reaction. The primary outcome was to compare the detected amounts of CEA and CK20 immediately after TME between the surgical methods.
Results
Among the 20 patients, 13 underwent LapTME and 7 underwent TaTME. Tumor location was lower in TaTME (7.3 cm vs. 4.6 cm, P=0.012), and negative mesorectal fascia (MRF) was more in LapTME (76.9% vs. 28.6%, P=0.044). CEA and CK20 levels were high in 3 patients (42.9%) only in TaTME. There was 1 case of T4 with incomplete purse-string suture and 1 case of positive MRF with dissection failure. All patients were followed up for an average of 32.5 months without local recurrence.
Conclusion
CEA and CK20 levels were high only in TaTME and were related to tumor factors or intraoperative events. However, whether the detection amount is clinically related to local recurrence remains unclear.

Technical Note

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas: Pankaj Garg, Anvesha Mongia; Ann Coloproctol. 2024;40(1):74-81. Published online October 24, 2023; DOI: https://doi.org/10.3393/ac.2022.01263.0180

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13 Citations

Abstract PDF

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

Citations

Citations to this article as recorded by

Perianal fistula a silent epidemic that face proctology and coloproctology in public health
Alida Vallejo-López , Josefina Ramírez-Amaya , Cesar Noboa-Terán
Salud, Ciencia y Tecnología.2025; 5: 1360. CrossRef
TROPIS is effective in managing complex anal fistulas with additional supralevator rectal opening (ASRO) by Garg phenomenon
Nicola Clemente, James C.W. Khaw, Yuliya Medkova, Pankaj Garg
Cirugía Española (English Edition).2025; 103(6): 800101. CrossRef
Response to the Letter to the Editor regarding our article on efficacy one year after the TROPIS Technique for the treatment of complex anal fistula
Fernando de la Portilla de Juan, María Luisa Reyes Díaz, Fátima Hinojosa Ramirez
Cirugía Española (English Edition).2025; 103(6): 800119. CrossRef
Respuesta a la carta al editor sobre nuestro artículo «Eficacia al año de la técnica TROPIS en la fístula perianal compleja»
Fernando de la Portilla de Juan, María Luisa Reyes Díaz, Fátima Hinojosa Ramirez
Cirugía Española.2025; 103(6): 800119. CrossRef
Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula
Yang-Tao Chen, Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Surgery Open Science.2025; 27: 15. CrossRef
TROPIS is effective in managing complex anal fistulas with additional supralevator rectal opening (ASRO) by Garg phenomenon
Nicola Clemente, James C.W. Khaw, Yuliya Medkova, Pankaj Garg
Cirugía Española.2025; 103(6): 800101. CrossRef
Transanal opening of intersphincteric space (TROPIS) treatment for high complex anal fistula: a systematic review and meta-analysis
Pengfei Zhou, Jingen Lu, Yanting Sun, Jiawen Wang
International Journal of Surgery.2025; 111(10): 7301. CrossRef
The Management of the Intersphincteric Component of Anal Fistula Tract Is Pivotal in Response to “A Pilot Study of Porcine Acellular Bladder Matrix Filling in the Treatment of Anal Fistulas”
Pankaj Garg, Vipul Yagnik, Kaushik Bhattacharya
ANZ Journal of Surgery.2025;[Epub] CrossRef
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Achieving a high cure rate in complex anal fistulas: understanding the conceptual role of the Garg cardinal principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Annals of Coloproctology.2024; 40(5): 521. CrossRef
Comparative Evaluation Between Cutting of the Intersphincteric Space vs Cutting Seton in High Anal Fistula: A Randomized Controlled Trial
Jiawei Qin, Yanlan Wu, Xueping Zheng, Kunlan Wu, Gongjian Dai, Yanyan Tan, Xu Yang, Yuqing Sun
Journal of the American College of Surgeons.2024; 239(6): 563. CrossRef
Invited Commentary: The Quest for the Panacea Treatment for Anal Fistula
Steven D Wexner
Journal of the American College of Surgeons.2024; 239(6): 573. CrossRef

Original Article

Anorectal benign disease

The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results: Shrivats Mishra, Dileep S. Thakur, Uday Somashekar, Amrendra Verma, Dhananjay Sharma; Ann Coloproctol. 2024;40(5):474-480. Published online March 31, 2023; DOI: https://doi.org/10.3393/ac.2022.01018.0145

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Abstract PDF

Purpose
Many methods have been used to treat complex fistulas, but no single technique has been considered standard. Damage to the sphincter may sometimes be unavoidable, and incontinence may be an important cause of morbidity. This study aimed to validate the results of transanal opening of the intersphincteric space (TROPIS), as a technique that avoids damaging the anal sphincter, in patients with complex fistula in ano.
Methods
A prospective study was conducted among 35 consecutive patients with complex fistula in ano. After a preoperative magnetic resonance fistulogram, TROPIS was performed in all patients. The St. Mark’s incontinence score was assessed preoperatively and postoperatively at 3 months.
Results
The tracts were intersphincteric in 16 patients, transsphincteric in 10, extrasphincteric in 2, and horseshoe in 3. Four patients had recurrent tracts (3 transsphincteric and 1 intersphincteric). A defined follow-up schedule was used. Curettage was done if postoperative pus drainage from the wound was noted. The fistula healed in 29 patients (82.89%) following TROPIS. The remaining 6 patients received curettage, with healing in 3 (overall healing rate, 91.4%). Patients who received curettage were followed for 3 months, and the outcome was labeled as healed or failed. The mean preoperative incontinence score was 0. One patient developed incontinence to gas postoperatively in week 2, but there was no significant change in the scores at 3 months postoperatively. The mean postoperative incontinence score was 0.02.
Conclusion
TROPIS is an effective method for the treatment of complex fistula in ano, with minimal risk for incontinence.

Citations

Citations to this article as recorded by

Transanal Opening of the Intersphincteric Space (TROPIS) Is Effective in Managing High Complex as It Is Based on Garg Cardinal Principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Digestive Diseases and Sciences.2025; 70(6): 2219. CrossRef
Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula
Yang-Tao Chen, Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Surgery Open Science.2025; 27: 15. CrossRef
Long-term Outcomes of Primary Fistula Closure With Platelet-Rich Plasma: A Prospective Study
María Luisa Reyes Díaz, Fátima Hinojosa Ramírez, Rocío Olmo Santiago, Irene M. Ramallo-Solís, Rosa M. Jiménez Rodríguez, José Pintor Tortolero, Jorge M. Vázquez-Monchul, Ana M. García Cabrera, Fernando de la Portilla de Juan
Diseases of the Colon & Rectum.2025; 68(8): 992. CrossRef
Transanal opening of intersphincteric space (TROPIS) treatment for high complex anal fistula: a systematic review and meta-analysis
Pengfei Zhou, Jingen Lu, Yanting Sun, Jiawen Wang
International Journal of Surgery.2025; 111(10): 7301. CrossRef
TROPIS Procedure in Complex Anal Fistulas: Single‐Center Long‐Term Results
Hikmet Pehlevan‐Özel, Zeynep Nur Yurdakul, Hüseyin Fahri Martlı, Sabiha Nur Özmen, Sadettin Er, Erdinç Çetinkaya, Tezcan Akın, Özgür Akgül
ANZ Journal of Surgery.2025;[Epub] CrossRef
Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024; 86(6): 1105. CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Structured magnetic resonance imaging and endoanal ultrasound anal fistulas reporting template (SMART): An interdisciplinary Delphi consensus
Iwona Sudoł-Szopińska, Pankaj Garg, Anders Mellgren, Antonino Spinelli, Stephanie Breukink, Francesca Iacobellis, Małgorzata Kołodziejczak, Przemysław Ciesielski, Jenssen Christian, Giulio Aniello Santoro
World Journal of Gastrointestinal Surgery.2024; 16(10): 3288. CrossRef
Botulinum injection technique to reduce spasms in refractory anal fissures and after anal fistula or hemorrhoid surgery
Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya
Annals of Coloproctology.2024; 40(6): 610. CrossRef

Review

Optimal anastomotic technique in rectal surgery to prevent anastomotic leakage: Daichi Kitaguchi, Masaaki Ito; Ann Coloproctol. 2023;39(2):97-105. Published online January 3, 2023; DOI: https://doi.org/10.3393/ac.2022.00787.0112

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Abstract PDF

Complications after colorectal surgery remain inevitable, and anastomotic leakage is one of the most severe and potentially fatal complications. Generally, anastomotic leakage is associated with severe peritonitis, the need for emergency reoperation, and an increased mortality rate. Additionally, particularly after rectal cancer surgery, it has a negative impact on long-term outcomes, including postoperative anorectal function, local recurrence, and survival. To prevent anastomotic leakage, understanding the characteristics of each anastomotic technique and establishing a stable anastomotic procedure are important. Transanal total mesorectal excision (TaTME) is a relatively new advanced surgical access technique for pelvic dissection and facilitates different anastomotic techniques without the need for transabdominal rectal transection. Especially, stapled anastomosis in TaTME, also known as double purse-string circular stapled anastomosis or the single stapling technique (SST), has gained much attention as an alternative to the conventional double stapling technique (DST). In this article, we describe the DST, SST, and hand-sewn anastomosis as anastomotic techniques after rectal surgery, focusing mainly on the differences between conventional anastomotic techniques and SST in TaTME. Furthermore, the blood flow evaluation method for the reconstructive colon before anastomosis, which is extremely important in anastomotic leakage prevention regardless of the anastomotic type, is also described.

Citations

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Neutrophil-to-lymphocyte ratio as an early predictor of anastomotic leakage after rectal cancer surgery
Yingjun Liu, Bing Han, Weifeng Xu, Youcai Wang, Mingke Huo, Jianwei Wang, Hongli Wang, Zhi Li
Surgery.2026; 190: 109829. CrossRef
Optimizing outcomes in anastomotic recurrence of rectal cancer: Efficacy of transanal total mesorectal excision
Mengqin Yu, Ximo Xu, Hao Zhong, Duohuo Shu, Naijipu Abuduaini, Jingyi Liu, Zhenfeng Huang, Haiqin Song, Sen Zhang, Xiao Yang, Zhenghao Cai, Gaojian Cao, Jianwen Li, Bo Feng
Current Problems in Surgery.2025; 66: 101748. CrossRef
Sphincter-preserving surgical techniques in low rectal cancer management: A systematic review of contemporary evidence
Song Wang, A-Jian Li, Hui-Hong Jiang, Yin Lin, Hai-Bo Ding
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
The robotic intracorporeal single-stapled anastomosis (RiSSA) technique in robotic left-sided colorectal resection: a technical note
Chih-Chien Wu, Yung-Lin Tan, Chao-Wen Hsu, Hsin-Ping Tseng, Danilo Miskovic, Shih-Feng Huang
Annals of Coloproctology.2025; 41(4): 357. CrossRef
Achieving the perfect end-to-end single-stapled anastomosis in low anterior resection for rectal cancer: technical aspects
Cherylin Wan Pei Fu
Annals of Coloproctology.2025; 41(4): 361. CrossRef
Comparative perioperative outcomes of articulated versus conventional straight devices in laparoscopic low anterior resection: a propensity score–matched analysis
Hayoung Lee, Yong Sik Yoon, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim
Annals of Coloproctology.2025; 41(5): 434. CrossRef
Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
Daichi Kitaguchi, Masaaki Ito
Annals of Coloproctology.2024; 40(4): 375. CrossRef
Successful Clinical Avoidance of Colorectal Anastomotic Leakage through Local Decontamination
Gerhard Ernst Steyer, Markus Puchinger, Johann Pfeifer
Antibiotics.2024; 13(1): 79. CrossRef
Combined Robotic Transanal Transection Single-Stapled Technique in Ultralow Rectal Endometriosis Involvement Associated With Parametrial and Vaginal Infiltration
Gianmarco D'Ancona, Benjamin Merlot, Quentin Denost, Stefano Angioni, Thomas Dennis, Horace Roman
Journal of Minimally Invasive Gynecology.2024; 31(4): 267. CrossRef
Risk factors for the failure of endoscopic balloon dilation to manage anastomotic stricture from colorectal surgery: retrospective cohort study
Young Il Kim, Seung Wook Hong, Seok-Byung Lim, Dong-Hoon Yang, Eon Bin Kim, Min Hyun Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Chang Sik Yu
Surgical Endoscopy.2024; 38(4): 1775. CrossRef
The impact of powered circular staplers on anastomotic leak in left-sided colorectal cancer surgeries
Hayoung Lee, Yong Sik Yoon, Young Il Kim, Eun Jung Park, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim
Surgical Endoscopy.2024; 38(10): 6111. CrossRef
Effect of powered circular stapler in colorectal anastomosis after left-sided colic resection: systematic review and meta-analysis
Andrea Scardino, Carlo Galdino Riva, Luca Sorrentino, Sara Lauricella, Alberto Aiolfi, Matteo Rottoli, Gianluca Bonitta, Marco Vitellaro, Luigi Bonavina, Davide Bona, Michael Kelly, Emanuele Rausa
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef
Optimal Indocyanine Green Dosage for Repetitive Angiography for Laparoscopic Colorectal Surgery
Gyung Mo Son, Sang-Ho Park, Nam Su Kim, Mi Sook Yun, In Young Lee, Myeong-Sook Kwon, Tae Kyun Kim, Eun Hwa Lee, Eun Jung Hwang, Kwang-Ryul Baek
Medicina.2024; 60(12): 1966. CrossRef
The Safe Values of Quantitative Perfusion Parameters of ICG Angiography Based on Tissue Oxygenation of Hyperspectral Imaging for Laparoscopic Colorectal Surgery: A Prospective Observational Study
Gyung Son, Armaan Nazir, Mi Yun, In Lee, Sun Im, Jae Kwak, Sang-Ho Park, Kwang-Ryul Baek, Ines Gockel
Biomedicines.2023; 11(7): 2029. CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef

Original Articles

Anorectal physiology & pelvic floor disorder

Does transanal endoscopic microsurgery affect rectal function?: Evgeniy Khomyakov, Stanislav Chernyshov, Oksana Fomenko, Evgeny Rybakov; Ann Coloproctol. 2023;39(4):326-331. Published online November 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00220.0031

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Abstract PDF

Purpose
Transanal endoscopic microsurgery (TEM) is the most standardized method for the local excision of rectal neoplasms. Unfortunately, local excisions of rectal lesions by means of TEM are not completely free from undesirable functional sequela. This study was performed to evaluate the risk factors of major loss of function after TEM.
Methods
Eighty-nine patients underwent TEM between 2019 and 2020. Anorectal manometry was performed before the surgery and 3, 6, and 12 months after the surgery. The quality of life (QoL) was assessed using the Fecal Incontinence Quality of Life scale.
Results
The major decrease in QoL was observed in women in 3 months after the surgery in terms of lifestyle and frustration domains (3.6 and 3.64 points, respectively). In 3 months after the surgery, there was a significant decrease in resting pressure both in male and female patients (P=0.01). This difference remained significant 6 months after the surgery (P=0.01). In 12 months after the surgery, resting pressure returned to the preoperative level in most patients (P=0.50). A significant decrease in manometric parameters appeared when the surgery time is more than 55 minutes (P=0.05), the tumor localization is lower than 3 cm from the anus (P=0.03), and the tumor size is over 3 cm (P=0.001).
Conclusion
The most significant risk factors for the development of functional disorders after TEM are surgery time of >55 minutes, tumor localization at <3 cm from the anal verge, and tumor size of >3 cm.

Citations

Citations to this article as recorded by

For Early Rectal Neoplasms, the Time Has Come to Move Beyond the Transanal Minimally Invasive Surgery Era: Endoscopic Submucosal Dissection Is No Longer the Challenger—It Is the Standard to Beat
Jeremie Jacques, Jon Steingrimsson
Gastroenterology.2025;[Epub] CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Colorectal cancer

Recurrence following transanal total mesorectal excision for rectal cancer: a monocentric retrospective series of technically difficult cases: Jonathan Frigault, Geneviève Morin, Sébastien Drolet, Philippe Bouchard, Alexandre Bouchard, Thanh-Quan Philips Ngo, François Letarte; Ann Coloproctol. 2023;39(4):332-341. Published online November 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00178.0025

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Abstract PDF: Purpose
Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate oncologic outcomes following TaTME.
Methods
This retrospective study included all consecutive patients with rectal cancer who had a TaTME from 2013 to 2019. The main outcome was the incidence of locoregional recurrence by the end of the follow-up period.
Results
Among a total of 81 patients, 96.3% were male, and their mean age was 63±9 years. The mean body mass index was 30.3±5.7 kg/m2, and the median distance from tumor to anal verge was 5.0 cm (interquartile range [IQR], 4.0–6.0 cm). Most patients had a low anterior resection performed (n=80, 98.8%) with a diverting ileostomy (n=64, 79.0%). Distal and circumferential resection margins were positive in 2.5% and 6.2% of patients, respectively. Total mesorectal excision was complete or near complete in 95.1% of patients. A successful resection was achieved in 72 patients (88.9%). After a median follow-up of 27.5 months (IQR, 16.7–48.1 months), 4 patients (4.9%) experienced locoregional recurrence. Anastomotic leaks were observed in 21 patients (25.9%). At the end of the follow-up, 69 patients (85.2%) were stoma-free.
Conclusion
TaTME was associated with acceptable oncological outcomes, including low locoregional recurrence rates in selected patients with low rectal cancer. Although associated with a high incidence of postoperative morbidities, the use of TaTME enabled a high rate of successful sphincter-saving procedures in selected patients who posed a technical challenge.

Review

Malignant disease,Rectal cancer,Surgical technique

Transanal total mesorectal excision for rectal cancer: it’s come a long way and here to stay: Jing Yu Ng, Chien-Chih Chen; Ann Coloproctol. 2022;38(4):283-289. Published online August 29, 2022; DOI: https://doi.org/10.3393/ac.2022.00374.0053

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15 Web of Science
16 Citations

Abstract PDF

Transanal total mesorectal excision (TaTME) was introduced as a novel technique to deal with rectal cancers. Its transanal approach offered the shortest distance to approach a challenging location, allowing an excellent visualization of the distal resection margin. Since its introduction in 2010, a significant amount of research has been put in to measure its development. In this review, we look at its ancestry, the genesis for its introduction and continued evolution as well as some of the important outcomes in its journey thus far. The importance of a structured and proctored learning journey is also stressed to enable the safe application and development of this technique. Beyond this, the TaTME movement has progressed relentlessly and its utility has been expanded to the management of benign conditions such as inflammatory bowel disease, Hartman reversals, and anastomotic strictures. We believe that the continued development and adoption of TaTME worldwide is here to stay.

Citations

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Rectal Eversion as an Anus-sparing Technique in Laparoscopic Low Anterior Resection With Double Stapling Anastomosis: Long-term Functional Results
Servet Karagul, Serdar Senol, Oktay Karakose, Huseyin Eken, Cuneyt Kayaalp
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2025;[Epub] CrossRef
Histopathological outcomes of transanal, robotic, open, and laparoscopic surgery for rectal cancer resection. A Bayesian network meta-analysis of randomized controlled trials
Nicola de’Angelis, Carlo Alberto Schena, Danila Azzolina, Maria Clotilde Carra, Jim Khan, Caroline Gronnier, Sébastien Gaujoux, Paolo Pietro Bianchi, Antonino Spinelli, Philippe Rouanet, Aleix Martínez-Pérez, Patrick Pessaux
European Journal of Surgical Oncology.2025; 51(1): 109481. CrossRef
Brief insight regarding the use of transanal, laparoscopic, and robotic total mesorectal excision for rectal cancer
Kevan English
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Oncological and Functional Outcomes After Minimally Invasive Surgery for Mid and Low Rectal Adenocarcinoma: A Review
Antonio Costanzo, Lorenzo Vescovi, Valentina Rampulla, Michela Caprioli, Michele Marini, Andrea Rigamonti, Daniele Passannanti, Valentina Crisafulli, Antonio Floridi
Cureus.2025;[Epub] CrossRef
Laparoscopic total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer: A systematic review and meta-analysis
Zhang Yi Chi, Ou Gang, Feng Xiao Li, Lu Ya, Zhou Zhijun, Du Yong Gang, Ran Dan, Liu Xin, Liu Yang, Zhang Peng, Luo Yi, Lin Dong, Zhang De Chun
Medicine.2024; 103(4): e36859. CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Quality of life and functional outcomes after laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (taTME) for rectal cancer. an updated meta-analysis
Sara Lauricella, Francesco Brucchi, Francesco Maria Carrano, Diletta Cassini, Roberto Cirocchi, Patricia Sylla
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Learning Curve for Robotic Colorectal Surgery
Neng Wei Wong, Nan Zun Teo, James Chi-Yong Ngu
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Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Case report on a rare complication after transanal total mesorectal excision (TaTME) for rectal malignancy vesicorectal fistula
Sapphire Melody Ho, Kishore Rajaguru, Jing Yu Ng, Choon Sheong Seow
International Journal of Surgery Case Reports.2023; 105: 108009. CrossRef
Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach
Ji-Hyun Seo, In-Ja Park
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Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
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Surgical Techniques for Transanal Local Excision for Early Rectal Cancer
Gyoung Tae Noh
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Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
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Hyun Gu Lee
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Original Articles

Benign proctology,Postoperative outcome & ERAS,Surgical technique

Early postoperative outcomes of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids: Shunya Takada, Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi; Ann Coloproctol. 2022;38(4):290-296. Published online November 2, 2021; DOI: https://doi.org/10.3393/ac.2020.00920.0131

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1 Web of Science
1 Citations

Abstract PDF

Purpose
Aluminum potassium sulfate and tannic acid (ALTA; Zion, Mitsubishi Pharma Corp.) is an effective sclerosing agent for internal hemorrhoids. ALTA therapy with a rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse. This study compared the early postoperative outcomes of AM surgery with Doppler-guided transanal hemorrhoidal dearterialization and mucopexy (DM) in patients with third-degree hemorrhoids.
Methods
AM surgery was performed on 32 patients with grade III hemorrhoids and was compared with a cohort of 22 patients who underwent DM surgery in a previous randomized controlled trial.
Results
The pain scores during defecation were significantly lower in the AM patients beginning 4 days after surgery. The total use of analgesics 2 weeks postoperatively was significantly lower in the AM patients than in the DM patients (3.5 tablets [range 1.6–5.5] vs. 7.6 tablets [range 3.3–11.9], P=0.04). The length of operation, blood loss, and incidence of postoperative complications were significantly lower in the AM patients than in the DM patients. During 12 months follow-up, recurrence of prolapse occurred in 1 patient who underwent AM surgery.
Conclusion
AM surgery is effective, with lower complication rates and postoperative analgesic requirements, and is a less invasive treatment for patients with grade III hemorrhoids compared to DM surgery.

Citations

Citations to this article as recorded by

Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
A. Tsunoda, H. Kusanagi
Techniques in Coloproctology.2023; 27(12): 1335. CrossRef

Benign diesease & IBD,Surgical technique

Transanal rectopexy for external rectal prolapse: Shantikumar Dhondiram Chivate, Meghana Vinay Chougule, Rahul Shantikumar Chivate, Palak Harshuk Thakrar; Ann Coloproctol. 2022;38(6):415-422. Published online October 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00262.0037

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201 Download
2 Web of Science
2 Citations

Abstract PDF

Purpose
The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance.
Methods
Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score.
Results
There were 36 adult patients (26 males; the range of age, 23–92 years). The mean operative time was 27 minutes (range, 23–50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48–84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001).
Conclusion
Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function.

Citations

Citations to this article as recorded by

Systematic literature review and meta-analysis of surgical treatment of complete rectal prolapse in male patients
S. H. Emile, A. Wignakumar, N. Horesh, Z. Garoufalia, V. Strassmann, M. Boutros, S. D. Wexner
Techniques in Coloproctology.2024;[Epub] CrossRef
External rectal prolapse: more than meets the eye
M. Yiasemidou, C. Yates, E. Cooper, R. Goldacre, I. Lindsey
Techniques in Coloproctology.2023; 27(10): 783. CrossRef

Case Reports

Malignant disease

Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation: Jae Young Kwak, Kwan Mo Yang, Hyun Il Seo; Ann Coloproctol. 2020;36(5):353-356. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.02.27

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99 Download

Abstract PDF: An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

Malignant disease

Transanal Endoscopic Microsurgery: Endoscopy Assisted Treatment of Colorectal Anastomotic Stenosis: Giancarlo D'Ambrosio, Antonietta Lamazza, Rossella Palma, Andrea Picchetto, Cristina Panetta, Antonello Trecca, Stefano Pontone, Emanuele Lezoche; Ann Coloproctol. 2020;36(4):285-288. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.30.3

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4 Citations

Abstract PDF

Transanal endoscopic microsurgery (TEM) is a type of natural orifice transluminal endoscopic surgery, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36-year-old woman with a diagnosis of Hirschsprung disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of preanastomotic colon (proximal colon from the anastomosis) was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM-colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique.

Citations

Citations to this article as recorded by

Application of transurethral prostate resection instrumentation for treating rectal anastomotic stenosis: Case series
Wenshan Xu, Yujie Qin, Faying Yang, Jun Qian, Yanbo Dong, Song Tu, Jiaxi Yao
Medicine.2023; 102(19): e33799. CrossRef
Eight Years Experience of Transanal Endoscopic Microsurgery
Seyed Vahid Hosseini, Mohammad Rezazadehkermani, Ali Abdulridha Abbas Algharah, Alimohammad Bananzadeh, Seyedeh Saeideh Shahidinia, Mehrdad Haghazali
Journal of Coloproctology.2023; 43(04): e251. CrossRef
Transanal Minimally Invasive Surgery for Rectal Anastomotic Stenosis After Colorectal Cancer Surgery
Wei Zhou, Lian Xia, Zian Wang, Gaoyang Cao, Li Chen, Engeng Chen, Wei Zhang, Zhangfa Song
Diseases of the Colon & Rectum.2022; 65(8): 1062. CrossRef
Application of endoscopic technique in completely occluded anastomosis with anastomotic separation after radical resection of colon cancer: a case report and literature review
Junnan Gu, Shenghe Deng, Yinghao Cao, Fuwei Mao, Hang Li, Huili Li, Jiliang Wang, Ke Wu, Kailin Cai
BMC Surgery.2021;[Epub] CrossRef

Original Articles

Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients: Vincenzo Consalvo, Francesca D’Auria, Vincenzo Salsano; Ann Coloproctol. 2019;35(3):118-122. Published online May 31, 2019; DOI: https://doi.org/10.3393/ac.2017.09.04

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5 Web of Science
7 Citations

Abstract PDF

Purpose
Despite the minimally invasive nature of transanal hemorrhoidal dearterialization (THD) with Doppler arterial identification procedures, hemorrhoidectomy is still considered the gold standard procedure for hemorrhoidal disease. However, the classical techniques of hemorrhoidectomy have a high rate of postoperative complications. The main purpose of this study is to demonstrate the efficacy and complications of these techniques used for grades II and III hemorrhoids.
Methods
A retrospective (case-control) study was carried out from January 2009 to May 2014, and all patients undergoing surgical procedures for hemorrhoidal disease in two French clinics were considered. Application of inclusion and exclusion criteria identified 270 eligible patients (163 undergoing Doppler THD and 107 treated with Milligan Morgan hemorrhoidectomy). Statistical analysis was calculated considering immediate postoperative complications, functional results, chronic complications, and recurrences.
Results
Analysis of primary outcomes showed a significant difference between the 2 groups concerning postoperative pain, which had a lower rate in THD (P = 0.0001) and in postoperative bleeding (P = 0.02) than hemorrhoidectomy. However, long-term follow-up at three years showed a superior rate of recurrence in the THD group (P = 0.009).
Conclusion
The THD technique is a safe and effective procedure for grades II and III hemorrhoids, has lower rates of post-operative pain and bleeding, and allows faster hospital discharge; however, it also shows a higher rate of recurrence at three years of follow-up.

Citations

Citations to this article as recorded by

Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study
Qing Long, Yong Wen, Jun Li
BMC Gastroenterology.2025;[Epub] CrossRef
Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: Long-term Outcomes From the THDLIGA Randomized Controlled Trial
Loris Trenti, Sebastiano Biondo, Eloy Espin-Basany, Oriana Barrios, Jose L. Sanchez-Garcia, • Aitor Landaluce-Olavarria, Elena Bermejo-Marcos, • Maria T. Garcia-Martinez, David Alias Jimenez, Fernando Jimenez, Adolfo Alonso, Maria B. Manso, Esther Kreisle
Diseases of the Colon & Rectum.2023; 66(8): e818. CrossRef
Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade III Hemorrhoidal Disease: The EMODART3 Multicenter Study
Antonio Giuliani, Lucia Romano, Stefano Necozione, Vincenza Cofini, Giada Di Donato, Mario Schietroma, Francesco Carlei
Diseases of the Colon & Rectum.2023; 66(12): e1254. CrossRef
CLINICAL AND MORPHOLOGICAL EVALUATION OF THE EFFECTIVENESS OF USING RADIO WAVE AND HIGH-FREQUENCY ELECTROSURGERY TECHNOLOGIES FOR THE TREATMENT OF COMBINED ANORECTAL DISEASES
V. V. Balytskyy, M. P. Zakharash, O. G. Kuryk
World of Medicine and Biology.2022; 18(80): 19. CrossRef
Linear Pinched Hemorrhoidectomy: A Retrospective Observational Study (An Innovative, Simplified Hemorrhoidectomy)
Akiharu Kurihara, Yu Yoshino, Yu Sakai, Yasuyuki Miura, Satoru Kagami, Tomoaki Kaneko, Mitsunori Ushigome, Hiroyuki Shiokawa, Hironori Kaneko, Kimihiko Funahashi
Journal of the Anus, Rectum and Colon.2021; 5(3): 261. CrossRef
Haemorrhoidal artery ligation with and without Doppler guidance in the treatment of haemorrhoidal disease: a single-centre randomized study
P. V. Tsarkov, M. A. Popovtsev, Yu. S. Medkova, A. V. Alekberzade, N. N. Krylov
Sechenov Medical Journal.2021; 12(3): 47. CrossRef
Hemorrhoidal artery ligation without Doppler navigation in surgical treatment of hemorrhoidal disease
M.A. Popovtsev, A.V. Alekberzade, N.N. Krylov
Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (12): 49. CrossRef

Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection: Mostafa Shalaby, Waleed Thabet, Oreste Buonomo, Nicola Di Lorenzo, Mosaad Morshed, Giuseppe Petrella, Mohamed Farid, Pierpaolo Sileri; Ann Coloproctol. 2018;34(6):317-321. Published online December 20, 2018; DOI: https://doi.org/10.3393/ac.2017.10.18

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15 Citations

Abstract PDF

Purpose
We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL).
Methods
Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL.
Results
Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2 ). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation.
Conclusion
These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

Citations

Citations to this article as recorded by

A Review of Postoperative Complications in Colon Cancer Surgery: The Need for Patient-Centered Therapy
Adrian Silaghi, Dragos Serban, Corneliu Tudor, Bogdan Mihai Cristea, Laura Carina Tribus, Irina Shevchenko, Alexandru Florin Motofei, Crenguta Sorina Serboiu, Vlad Denis Constantin
Journal of Mind and Medical Sciences.2025; 12(1): 21. CrossRef
Management of anastomotic leakage after low anterior resection with double-stapling anastomosis
Kenji Kawada, Yoshiro Itatani, Kazutaka Obama
Journal of Gastrointestinal Surgery.2025; 29(10): 102178. CrossRef
Challenges in the interdisciplinary treatment of leakages after left-sided colorectal surgery: endoscopic negative pressure therapy, open-pore film drainage therapy and beyond
Pasquale Scognamiglio, Anja Seeger, Matthias Reeh, Nathaniel Melling, Karl F Karstens, Thomas Rösch, Jakob R Izbicki, Marcus Kantowski, Michael Tachezy
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Significance of information obtained during transanal drainage tube placement after anterior resection of colorectal cancer
Yuki Okazaki, Masatsune Shibutani, Hisashi Nagahara, Tatsunari Fukuoka, Yasuhito Iseki, En Wang, Kiyoshi Maeda, Kosei Hirakawa, Masaichi Ohira, Zubing Mei
PLOS ONE.2022; 17(8): e0271496. CrossRef
The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma
Seok Hyeon Cho, In Kyu Lee, Yoon Suk Lee, Min Ki Kim
Annals of Surgical Treatment and Research.2021; 100(2): 100. CrossRef
Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery
Deborah S. Keller, K. Talboom, C.P.M van Helsdingen, Roel Hompes
Clinics in Colon and Rectal Surgery.2021; 34(06): 431. CrossRef
Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer
Xiaojie Tan, Mei Zhang, Lai Li, He Wang, Xiaodong Liu, Haitao Jiang
Journal of International Medical Research.2021;[Epub] CrossRef
Improved colorectal anastomotic leakage healing by transanal rinsing treatment after endoscopic vacuum therapy using a novel patient-applied rinsing catheter
Marcus Kantowski, Andreas Kunze, Eugen Bellon, Thomas Rösch, Utz Settmacher, Michael Tachezy
International Journal of Colorectal Disease.2020; 35(1): 109. CrossRef
Surgical complications in colorectal cancer patients
Haleh Pak, Leila Haji Maghsoudi, Ali Soltanian, Farshid Gholami
Annals of Medicine and Surgery.2020; 55: 13. CrossRef
Effect comparison of three different types of transanal drainage tubes after anterior resection for rectal cancer
Yun Luo, Chang-Kang Zhu, Ding-Quan Wu, Liang-Bi Zhou, Chong-Shu Wang
BMC Surgery.2020;[Epub] CrossRef
Percutaneous transesophageal gastro-tubing for the management of anastomotic leakage after upper GI surgery: a report of two clinical cases
Yutaka Tamamori, Katsunobu Sakurai, Naoshi Kubo, Ken Yonemitsu, Yasuhiro Fukui, Junya Nishimura, Kiyoshi Maeda, Yukio Nishiguchi
Surgical Case Reports.2020;[Epub] CrossRef
Long-Term Results after Anastomotic Leakage following Rectal Cancer Surgery: A Comparison of Treatment with Endo-Sponge and Transanal Irrigation
Alice Weréen, Martin Dahlberg, Göran Heinius, Emil Pieniowski, Deborah Saraste, Karolina Eklöv, Jonas Nygren, Klas Pekkari, Åsa H. Everhov
Digestive Surgery.2020; 37(6): 456. CrossRef
Preventive strategies for anastomotic leakage after colorectal resections: A review
Mostafa Shalaby, Waleed Thabet, Mosaad Morshed, Mohamed Farid, Pierpaolo Sileri
World Journal of Meta-Analysis.2019; 7(8): 389. CrossRef
Transanal surgery: A tool in colorectal anastomotic leakage
Pere Planellas Giné, Júlia Gil Garcia, Ramon Farrés Coll, Antoni Codina Cazador
Cirugía Española (English Edition).2019; 97(10): 590. CrossRef
La cirugía transanal como herramienta en la dehiscencia de la anastomosis colorrectal
Pere Planellas Giné, Júlia Gil Garcia, Ramon Farrés Coll, Antoni Codina Cazador
Cirugía Española.2019; 97(10): 590. CrossRef

Transanal Endoscopic and Transabdominal Robotic Total Mesorectal Excision for Mid-to-Low Rectal Cancer: Comparison of Short-term Postoperative and Oncologic Outcomes by Using a Case-Matched Analysis: Ki Young Lee, Jung Kyoung Shin, Yoon Ah Park, Seong Hyeon Yun, Jung Wook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee; Ann Coloproctol. 2018;34(1):29-35. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.29

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21 Web of Science
20 Citations

Abstract PDF

Purpose

This study aimed to compare short-term postoperative and oncologic outcomes of a transanal endoscopic total mesorectal excision (TME) to those of a transabdominal robotic TME.

Methods

A total of 62 patients with rectal cancer underwent transanal (n = 26) or robotic (n = 36) TME between June 2013 and December 2014. After case-matching by tumor location and TNM stage, 45 patients were included for analysis. The median follow-up period was 21.3 months. Operative, histopathologic and postoperative outcomes and recurrences were analyzed.

Results

Patients younger than 60 years of age were more frequently observed in the robotic TME group (75.0% vs. 47.6%, P = 0.059), but tumor location, cT and cN category, and preoperative chemoradiotherapy were not different between the 2 groups. Estimated blood loss was greater in the transanal group (283 mL vs. 155 mL, P = 0.061); however, the operation time and the rate of a diverting ileostomy and subsequent ileostomy repair were not different between the groups. The proximal resection margin was longer in the transanal TME group (20.8 cm ± 16.0 cm, P = 0.030), but the distal resection margins, involvements of the circumferential resection margin, TME quality, numbers of retrieved lymph nodes, postoperative complications, including anastomotic leak and voiding difficulty, and recurrence rates for the 2 groups were not statistically different.

Conclusion

Transanal endoscopic and transabdominal robotic TME showed similar histopathologic and postoperative outcomes with the exception of the estimated blood loss and the proximal resection margin for a select group of patients.

Citations

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Systematic review and meta-analysis comparing robotic total mesorectal excision versus transanal total mesorectal excision for rectal cancer
Mohamed Ali Chaouch, Mohammad Iqbal Hussain, Maissa Jellali, Amine Gouader, Alessandro Mazzotta, Adriano Carneiro da Costa, Bassem Krimi, Jim Khan, Hani Oweira
Scandinavian Journal of Surgery.2025; 114(1): 73. CrossRef
EAES, ESCP, and ESGAR update on taTME for rectal cancer–systematic review and meta-analysis
Bright Huo, Alberto Arezzo, Dana Sochorova, Amy Boyle, Yegor Tryliskyy, Iro Ntaga, Dimitris Mavridis, Michel Adamina, Patricia Sylla, Rosa Jiménez-Rodriguez, Dimitris Ntourakis, Dorin Popa, Audrius Dulskas, Sofia Gourtsoyianni, Vincenzo Villanacci, Ivan F
Surgical Endoscopy.2025;[Epub] CrossRef
Peri-operative, oncological and functional outcomes of robotic versus transanal total mesorectal excision in patients with rectal cancer: A systematic review and meta-analysis
A. Y. Y. Mohamedahmed, S. Zaman, A. A. Wuheb, A. Ismail, M. Nnaji, A. A. Alyamani, H. A. Eltyeb, N. A. Yassin
Techniques in Coloproctology.2024;[Epub] CrossRef
A systematic review and meta-analysis of minimally invasive total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer
Du Yong Gang, Lin Dong, Zhang DeChun, Zhang Yichi, Lu Ya
Frontiers in Oncology.2023;[Epub] CrossRef
Robotic-assisted laparoscopic low anterior resection versus trans-anal total mesorectal excision for malignant rectal lesion: a prospective cohort trial
Ahmed F.A. Farag, Ahmed M.A. Mahmoud, Haitham M. Azmy, Abdrabbou N. Mashhour, Ahmed S. Khalifa, Yasser Debakey, Mohamed Y. Elbarmelgi
The Egyptian Journal of Surgery.2023; 42(4): 859. CrossRef
Robotic or transanal total mesorectal excision (TaTME) approach for rectal cancer, how about both? Feasibility and outcomes from a single institution
Yusuke Inoue, Jing Yu Ng, Chun-Ho Chu, Yi-Ling Lai, I.-Ping Huang, Shung-Haur Yang, Chien-Chih Chen
Journal of Robotic Surgery.2022; 16(1): 149. CrossRef
Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer: a systematic review and meta-analysis
Jae Young Moon, Min Ro Lee, Gi Won Ha
Surgical Endoscopy.2022; 36(5): 3122. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Comparison of transanal total mesorectal excision and robotic total mesorectal excision for low rectal cancer after neoadjuvant chemoradiotherapy
Jung Kyong Shin, Hee Cheol Kim, Seong Hyeon Yun, Yoon Ah Park, Yong Beom Cho, Jung Wook Huh, Woo Yong Lee
Surgical Endoscopy.2021; 35(12): 6998. CrossRef
Statistical, Clinical, Methodological Evaluation of Local Recurrence Following Transanal Total Mesorectal Excision for Rectal Cancer: A Systematic Review
Hans H. Wasmuth, Mahir Gachabayov, Les Bokey, Abe Fingerhut, Guy R. Orangio, Feza H. Remzi, Roberto Bergamaschi
Diseases of the Colon & Rectum.2021; 64(7): 899. CrossRef
A nationwide comparison of short‐term outcomes after transanal, open, laparoscopic, and robot‐assisted total mesorectal excision
Ilze Ose, Sharaf Karim Perdawood
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Robotic total mesorectal excision or transanal total mesorectal excision meta‐analysis
Michelle Zhiyun Chen, Yeng Kwang Tay, Satish K. Warrier, Alexander G. Heriot, Joseph C. Kong
ANZ Journal of Surgery.2021; 91(11): 2269. CrossRef
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J. W. Butterworth, W. A. Butterworth, J. Meyer, C. Giacobino, N. Buchs, F. Ris, R. Scarpinata
Techniques in Coloproctology.2021; 25(11): 1183. CrossRef
Outcomes of robotic low anterior resection versus transanal total mesorectal excision for rectal cancer
J L B Buan, W Z So, X C Lim, C S Chong
BJS Open.2021;[Epub] CrossRef
Initial Experience of Robotic Total Mesorectal Excision for Rectal Cancer
Jung Kyong Shin, Jung Wook Huh
Annals of Robotic and Innovative Surgery.2020; 1(1): 33. CrossRef
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Je-Ho Jang, Chang-Nam Kim
Annals of Coloproctology.2020; 36(5): 293. CrossRef
Systemic review and network meta‐analysis comparing minimal surgical techniques for rectal cancer: quality of total mesorectum excision, pathological, surgical, and oncological outcomes
Emanuele Rausa, Federica Bianco, Michael E. Kelly, Alberto Aiolfi, Fausto Petrelli, Gianluca Bonitta, Giovanni Sgroi
Journal of Surgical Oncology.2019; 119(7): 987. CrossRef
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Mahir Gachabayov, Inna Tulina, Roberto Bergamaschi, Petr Tsarkov
Surgical Oncology.2019; 30: 47. CrossRef
Transanal Total Mesorectal Excision for Rectal Cancer: Perioperative and Oncological Outcomes
Hyuk Hur
Annals of Coloproctology.2018; 34(1): 1. CrossRef
Evolution of surgery for rectal cancer: Transanal total mesorectal excision~new standard or fad?~
Hirotoshi Hasegawa, Koji Okabayashi, Masashi Tsuruta, Takashi Ishida, Fumitaka Asahara, Mark G Coleman
Journal of the Anus, Rectum and Colon.2018; 2(4): 115. CrossRef

Case Report

Pneumoretroperitoneum and Sepsis After Transanal Endoscopic Resection of a Rectal Lateral Spreading Tumor: Bruno Augusto Alves Martins, Marcelo de Melo Andrade Coura, Romulo Medeiros de Almeida, Natascha Mourão Moreira, João Batista de Sousa, Paulo Gonçalves de Oliveira; Ann Coloproctol. 2017;33(3):115-118. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.115

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5 Citations

Abstract PDF

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.

Citations

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Massive pneumoperitoneum and subcutaneous emphysema after transanal resection of a rectal tumor: Case report and comprehensive review of the literature
P Bretcha Boix, Marie Stephanie Nunez Duarte, A Dieter, R Silver
Journal of Case Reports and Images in Surgery.2025; 11(1): 31. CrossRef
Emphysema as a complication after transanal endoscopic microsurgery (TEM) (case report and review)
E. A. Khomyakov, T. A. Eryshova, M. V. Kapitanov, S. V. Chernyshov, E. G. Rybakov
Koloproktologia.2023; 22(4): 113. CrossRef
Approach to the patient with pneumoretroperitoneum
Sumudu Welikumbura, Toan Pham, Anshini Jain, Marli Williams, Philip Smart
ANZ Journal of Surgery.2021; 91(1-2): 206. CrossRef
Penetration into free abdominal cavity during transanal endoscopic rectal resection for adenoma
Yu. A. Gevorkyan, N. V. Soldatkina, V. E. Kolesnikov, D. A. Kharagezov, A. V. Dashkov, S. I. Poluektov, N. S. Samoylenko
South Russian Journal of Cancer.2021; 2(1): 43. CrossRef
Ectopic air localizations after transanal procedures: A systematic literature review
Andrea Balla, Silvia Quaresima, Alessandro M. Paganini
International Journal of Surgery.2018; 56: 167. CrossRef

Original Articles

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience: Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Narimantas E. Samalavicius; Ann Coloproctol. 2017;33(1):23-27. Published online February 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.1.23

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12 Web of Science
15 Citations

Abstract PDF

Purpose

The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM).

Methods

Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences.

Results

The average tumor size was 2.8 ± 1.5 cm (range, 0.5–8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days.

Conclusion

TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.

Citations

Citations to this article as recorded by

TEMPOUR: A Randomized Controlled Trial Assessing Perioperative Use of an Alpha-1 Blocker to Reduce Postoperative Urinary Retention After Transanal Endoscopic Microsurgery Procedures
Thomas Couture, Claudya Morin, Janyssa Charbonneau, Émilie Papillon-Dion, Alexandre Bouchard, François Rouleau-Fournier, Philippe Bouchard, François Letarte, Alexis F. Turgeon, Sebastien Drolet
Diseases of the Colon & Rectum.2025; 68(4): 475. CrossRef
The Outcome of Local Excision of Rectal Adenomas with High-Grade Dysplasia by Transanal Endoscopic Microsurgery: A Single-Center Experience
Muhammad Khalifa, Rachel Gingold-Belfer, Nidal Issa
Journal of Clinical Medicine.2024; 13(5): 1419. CrossRef
Transanal endoscopic rectal resection: immediate and long-term results
A.A. Maslov, Yu.A. Gevorkyan, N.V. Soldatkina, A.V. Dashkov, S.I. Poluektov, V.E. Kolesnikov, D.O. Kaymakchi, A.V. Snezhko
Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (1): 30. CrossRef
Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal
Xavier Serra-Aracil, Victoria Lucas-Guerrero, Laura Mora-López
Clinics in Colon and Rectal Surgery.2022; 35(02): 129. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Is Local Resection of Anal Canal Tumors Feasible with Transanal Endoscopic Surgery?
Xavier Serra‐Aracil, Andrea Campos‐Serra, Laura Mora‐López, Sheila Serra‐Pla, Anna Pallisera‐Lloveras, Roser Flores‐Clotet, Alba Zárate‐Pinedo, Salvador Navarro‐Soto
World Journal of Surgery.2020; 44(3): 939. CrossRef
Transanal endoscopic microsurgery for a rectal polyp – a video vignette
N. E. Samalavicius, P. Kavaliauskas, A. Dulskas
Colorectal Disease.2020; 22(9): 1203. CrossRef
Endoscopic diagnosis of gastrointestinal melanoma
Sheng Wang, Siyu Sun, Xiang Liu, Nan Ge, Guoxin Wang, Jintao Guo, Wen Liu, Jinlong Hu
Scandinavian Journal of Gastroenterology.2020; 55(3): 330. CrossRef
Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis
Audrius Dulskas, Aivaras Atkociunas, Alfredas Kilius, Kestutis Petrulis, Narimantas E. Samalavicius
Visceral Medicine.2019; 35(3): 151. CrossRef
Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience
M. Ondhia, P. Tamvakeras, P. O'Toole, A. Montazerri, T. Andrews, C. Farrell, S. Ahmed, S. Slawik, S. Ahmed
Colorectal Disease.2019; 21(10): 1164. CrossRef
Transanal Endoscopic Microsurgery for Patients with Rare Rectal Tumors
Xin Wu, Guole Lin, Huizhong Qiu, Jiaolin Zhou
Journal of Laparoendoscopic & Advanced Surgical Techniques.2018; 28(5): 546. CrossRef
Modern management of T1 rectal cancer by transanal endoscopic microsurgery: a 10‐year single‐centre experience
H. J. S. Jones, R. Hompes, N. Mortensen, C. Cunningham
Colorectal Disease.2018; 20(7): 586. CrossRef
Transanal endoscopic microsurgery as day surgery – a single‐centre experience with 500 patients
C. J. Brown, J. Q. Gentles, T. P. Phang, A. A. Karimuddin, M. J. Raval
Colorectal Disease.2018;[Epub] CrossRef
Transanal Endoscopic Microsurgery
Byung Chun Kim
Annals of Coloproctology.2017; 33(1): 5. CrossRef
Transanal endoscopic microsurgery for giant benign rectal tumours: is large size a contraindication?
Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Narimantas E. Samalavicius
International Journal of Colorectal Disease.2017; 32(12): 1759. CrossRef

Transanal Endoscopic Microsurgery for the Treatment of Well-Differentiated Rectal Neuroendocrine Tumors: Hyoung Ran Kim, Woo Yong Lee, Kyung Uk Jung, Hyuk Jun Chung, Chul Joong Kim, Hae-Ran Yun, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Ho-Kyung Chun; J Korean Soc Coloproctol. 2012;28(4):201-204. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.201

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10 Citations

Abstract PDF

Purpose

Recently, an increase in well-differentiated rectal neuroendocrine tumors (WRNETs) has been noted. We aimed to evaluate transanal endoscopic microsurgery (TEM) for the treatment of WRNETs.

Methods

Between December 1995 and August 2009, 109 patients with WRNETs underwent TEM. TEM was performed for patients with tumors sizes of up to 20 mm and without a lymphadenopathy. These patients had been referred from other clinics after having been diagnosed with WRNETs by using a colonoscopic biopsy; they had undergone a failed endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) and exhibited an involved resection margin and remaining tumor after ESD or EMR, regardless of the distance from the anal verge. This study included 38 patients that had more than three years of follow-up.

Results

The mean age of the patients was 51.3 ± 11.9 years, the mean tumor size was 8.0 ± 3.9 mm, and no morbidity occurred. Thirty-five patients were asymptomatic. TEM was performed after a colonoscopic resection in 13 cases because of a positive resection margin, a residual tumor or a non-lifting lesion. Complete resections were performed in 37 patients; one patient with a positive margin was considered surgically complete. In one patient, liver metastasis and a recurrent mesorectal node occurred after five and 10 years, respectively.

Conclusion

TEM might provide an accessible and effective treatment either as an initial or as an adjunct after a colonoscopic resection for a WRNET.

Citations

Citations to this article as recorded by

Transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors: a retrospective 10-year single-center experience
Marek Szczepkowski, Piotr Witkowski, Alicja Przywózka-Suwała, Karolina Skonieczna-Żydecka, Teresa Starzyńska, Krzysztof Dąbkowski
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Endoscopic Submucosal Dissection and Transanal Endoscopic Microsurgery in the Treatment of Rectal Neuroendocrine Tumors: Systematic Review and Meta-Analysis of the Observational Studies
Krzysztof Dąbkowski, Karolina Skonieczna-Żydecka, Katarzyna Gaweł, Wojciech Marlicz, Piotr Szredzki, Andrzej Białek
Clinical and Translational Gastroenterology.2025;[Epub] CrossRef
Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study
Jimin Son, In Ja Park, Dong-Hoon Yang, Jisup Kim, Kyoung-Jo Kim, Jeong-Sik Byeon, Seung Mo Hong, Young Il Kim, Jong Beom Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Surgical Endoscopy.2022; 36(4): 2445. CrossRef
Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors
Wei-Kun Shi, Rui Hou, Yun-Hao Li, Xiao-Yuan Qiu, Yu-Xin Liu, Bin Wu, Yi Xiao, Jiao-Lin Zhou, Guo-Le Lin
BMC Surgery.2022;[Epub] CrossRef
Non-conventional applications for transanal endoscopic microsurgery. A single center experience and a systematic review of literature
Rosita DE VINCENTI, Fabio CIANCHI, Francesco CORATTI
Minerva Surgery.2022;[Epub] CrossRef
Transanalis műtéti útmutató – második kiadás
Kálmán Almási, Szabolcs Ábrahám, József Baracs, Attila Bursics, Zoltán Jánó, Tamás Sztipits, Áron Szűts, Dezső Tóth, Attila Zaránd, Balázs Bánky
Orvosi Hetilap.2022; 163(Supplement): 3. CrossRef
Endoscopic submucosal dissection versus transanal local excision for rectal carcinoid: a comparative study
Fei-hu Yan, Zheng Lou, Shi-jie Hu, Xiao-dong Xu, Hao Wang, Han-tao Wang, Rong-gui Meng, Chuan-gang Fu, Wei Zhang, Jian He, En-da Yu
World Journal of Surgical Oncology.2016;[Epub] CrossRef
Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis
Lei He, Tao Deng, Hesheng Luo
Yonsei Medical Journal.2015; 56(1): 72. CrossRef
Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors
Wei-Jie Chen
World Journal of Gastroenterology.2015; 21(30): 9142. CrossRef
Current Issues Involving the Treatment of Small Rectal Carcinoid Tumors
Dae Kyung Sohn
Journal of the Korean Society of Coloproctology.2012; 28(4): 176. CrossRef

Case Report

Treatment of a Recurrent Rectourethral Fistula by Using Transanal Rectal Flap Advancement and Fibrin Glue: A Case Report: Taek-Gu Lee, Sung-Su Park, Sang-Jeon Lee; J Korean Soc Coloproctol. 2012;28(3):165-169. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.165

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10 Citations

Abstract PDF

Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence.

Citations

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Fistules recto-urétrales après traitement pour cancer de la prostate : mise au point et nouvel algorithme de prise en charge
Maëlig Poitevin, Matthieu Ferragu, Pierre Bigot, Thibaut Culty, Aurélien Venara
Journal de Chirurgie Viscérale.2025; 162(3): 213. CrossRef
Rectourethral fistulas after treatment for prostate carcinoma: Update and new management algorithm
Maëlig Poitevin, Matthieu Ferragu, Pierre Bigot, Thibaut Culty, Aurélien Venara
Journal of Visceral Surgery.2025; 162(3): 199. CrossRef
“Robotic-assisted surgical management of a post-brachytherapy rectoprostatic fistula: a case report”
Artem Goncharov, Vadim Shindyapin, Alexander Popov, Aramais Aslanyan, Emil Abdryakhimov
BMC Urology.2025;[Epub] CrossRef
Rectourethral fistula following focal irreversible electroporation for prostate cancer
Sean Ong, Zein Alhamdani, Nathan Lawrentschuk
BMJ Case Reports.2022; 15(9): e249816. CrossRef
Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal
J.U. Juan Escudero, F. Villalba Ferrer, M. Ramos de Campos, M. Fabuel Deltoro, M.J. García Coret, F. Sánchez Ballester, I. Povo Martín, Y. Pallas Costa, P. Pardo Duarte, J. García Ibañez, A. Monzó Cataluña, K. Rechi Sierra, C. Juliá Romero, E. López Alcin
Actas Urológicas Españolas.2021; 45(5): 398. CrossRef
Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access
J.U. Juan Escudero, F. Villaba Ferrer, M. Ramos de Campos, M. Fabuel Deltoro, M.J. Garcia Coret, F. Sanchez Ballester, I. Povo Martín, Y. Pallas Costa, P. Pardo Duarte, J. García Ibañez, A. Monzó Cataluña, K. Rechi Sierra, C. Juliá Romero, E. Lopez Alcina
Actas Urológicas Españolas (English Edition).2021; 45(5): 398. CrossRef
A rare case of tubercular recto-prostatic urethral fistula with tuberculous orchitis
Niramya Pathak, Mohan Keshavamurthy, Karthik Rao, Shakir Tabrez, Mohan Balaiah Ashwathaiya, Premakumar Krishnappa
Urology Case Reports.2020; 33: 101355. CrossRef
Management of acquired rectourethral fistulas in adults
Shulian Chen, Rang Gao, Hong Li, Kunjie Wang
Asian Journal of Urology.2018; 5(3): 149. CrossRef
Re-operative surgery for genitourinary fistulae to the colorectum
Gokulakkrishna Subhas, Suraj Alva, Walter E. Longo
Seminars in Colon and Rectal Surgery.2015; 26(4): 229. CrossRef
Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods
Ji Hye Choi, Byeong Geon Jeon, Sang-Gi Choi, Eon Chul Han, Heon-Kyun Ha, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Kyu Joo Park
Annals of Coloproctology.2014; 30(1): 35. CrossRef

Original Articles

Comparison of Long-term Clinical Outcomes according to the Change in the Rectocele Depth between Transanal and Transvaginal Repairs for a Symptomatic Rectocele: Choon Sik Chung, Sang Hwa Yu, Jeong Eun Lee, Dong Keun Lee; J Korean Soc Coloproctol. 2012;28(3):140-144. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.140

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13 Citations

Abstract PDF

Purpose

This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure.

Methods

Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months.

Results

On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 ± 0.20 vs. 2.25 ± 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (≥4 cm) after the procedure (P = 0.001)

Conclusion

In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.

Citations

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Outcomes of laparoscopic ventral mesh rectopexy versus trans-vaginal repair in management of anterior rectocele, a randomized controlled trial
A. Sanad, A. Sakr, H. Elfeki, W. Omar, W. Thabet, E. Fouda, E. Abdallah, S. A. Elbaz
Techniques in Coloproctology.2025;[Epub] CrossRef
Tratamiento quirúrgico de los prolapsos genitales por vía vaginal
T. Thubert, M. Degez, C. Cardaillac, R. De Tayrac, M. Cosson
EMC - Urología.2024; 56(4): 1. CrossRef
Traitement chirurgical des prolapsus génitaux par voie vaginale
T. Thubert, M. Degez, C. Cardaillac, R. De Tayrac, M. Cosson
EMC - Techniques Chirurgicales - Urologie.2024; 41(3): 1. CrossRef
Laparoscopic or transanal repair of rectocele? Comparison of a reduction in rectocele size
Akira Tsunoda, Tomoko Takahashi, Satoshi Matsuda, Hiroshi Kusanagi
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Prise en charge chirurgicale de la rectocele – mise au point
M. Aubert, D. Mege, R. Le Huu Nho, G. Meurette, I. Sielezneff
Journal de Chirurgie Viscérale.2021; 158(2): 157. CrossRef
Surgical management of the rectocele – An update
M. Aubert, D. Mege, R. Le Huu Nho, G. Meurette, I. Sielezneff
Journal of Visceral Surgery.2021; 158(2): 145. CrossRef
ACG Clinical Guidelines: Management of Benign Anorectal Disorders
Arnold Wald, Adil E. Bharucha, Berkeley Limketkai, Allison Malcolm, Jose M. Remes-Troche, William E. Whitehead, Massarat Zutshi
American Journal of Gastroenterology.2021; 116(10): 1987. CrossRef
Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse
Fabio Gaj, Ivano Biviano, Antonello Trecca, Quirino Lai, Jacopo Andreuccetti
Minerva Chirurgica.2020;[Epub] CrossRef
Absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with rectal intussusception and fecal incontinence
Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi
International Journal of Colorectal Disease.2019; 34(10): 1681. CrossRef
Trattamento chirurgico del rettocele
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Tecniche Chirurgiche Addominale.2018; 24(1): 1. CrossRef
Tratamiento quirúrgico de los rectoceles
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Técnicas Quirúrgicas - Aparato Digestivo.2018; 34(1): 1. CrossRef
Surgery for constipation: systematic review and practice recommendations
U. Grossi, E. J. Horrocks, J. Mason, C. H. Knowles, A. B. Williams
Colorectal Disease.2017; 19(S3): 73. CrossRef
Traitement chirurgical des rectocèles
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Techniques chirurgicales - Appareil digestif.2017; 34(4): 1. CrossRef

The Feasibility of an Ex-vivo Sentinel Lymph Mapping Using Preoperative Radioisotope Injection in Cases of Extraperitoneal Rectal Cancer: Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Soo Yeon Park, Yun Jung Park, Sang-Woo Lee, Ziguang Xu, Han Ik Bae; J Korean Soc Coloproctol. 2011;27(2):83-89. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.83

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Abstract PDF

Purpose

The purpose of this research was to evaluate the feasibility of sentinel lymph node (SLN) mapping involving transanal injection with an ex-vivo mapping in patients with rectal cancer.

Methods

Between April 2007 and December 2009, 20 consecutive patients with T1-3, N0-1 clinical stage rectal cancer preoperatively underwent a SLN procedure using submucosal ^99mTc-phytate injection. All the patients underwent a total mesorectal excision. After the standard surgical resection, all specimens were identified on lymphoscintigraphy, and bench work was done to pick up the sentinel node basin. All the lymph nodes (non-SLNs and SLNs) were examined using conventional hematoxylin and eosin staining and immunohistochemistry with anti-cytokeratin antibodies.

Results

SLNs were identified from 19 of 20 patients with rectal cancer. The total number of sentinel nodes retrieved from the surgical specimens was 29, and the mean number per patient was 1.6 (range, 0 to 4). In three patients, the SLN was the only positive lymph node. There was one false-negative case with a sensitivity of 88.8% and two upstaged cases (20.0%). The SLN samples from rectal cancer are mainly localized in the pararectal region, but aberrant nodes receive direct drainage from the rectal cancer. On planar lymphoscintigraphy, 15.7% of all patients had aberrant lymphatic drainage to the sigmoid mesenteric or sigmoid lymph node station.

Conclusion

In conclusion, the intraoperative transanal injection for ex-vivo SLN navigation is a safe, feasible surgical modality in patients with rectal cancer. Large studies are warranted to determine the clinical significance of the SLN concept and micrometastasis in rectal cancer.

Citations

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Comparing the efficacy of routine H&E staining and cytokeratin immunohistochemical staining in detection of micro-metastasis on serial sections of dye-mapped sentinel lymph nodes in colorectal carcinoma
Mohammad Hossein Sanei, Seid Abbas Tabatabie, Seid Mozafar Hashemi, Ali Cherei, Parvin Mahzouni, Behnam Sanei
Advanced Biomedical Research.2016;[Epub] CrossRef
In vivo lymph node mapping and pattern of metastasis spread in locally advanced mid/low rectal cancer after neoadjuvant chemoradiotherapy
E. Farinella, L. Viganò, M. C. Fava, M. Mineccia, F. Bertolino, L. Capussotti
International Journal of Colorectal Disease.2013; 28(11): 1523. CrossRef
A rectumtumorok sebészete
Péter Metzger
Magyar Sebészet.2012; 65(3): 129. CrossRef

Clinical Outcome of a Rectovaginal Fistula in Crohn's Disease.: Chung, Choon Sik , Lee, Dong Keun , George, Bruce D , Mortensen, Neil J; J Korean Soc Coloproctol. 2007;23(1):10-15.; DOI: https://doi.org/10.3393/jksc.2007.23.1.10

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3 Citations

Abstract PDF

PURPOSE
The aim of this study is to analyze the outcome of a variety of treatments, including local surgical treatments, diverting stoma, and combined medical therapy, for patients with a rectovaginal fistula complicating Crohn's disease.
METHODS
Between 1994 and 2003, twenty-one patients with a rectovaginal fistula complicating Crohn's disease from a prospectively compiled 422-patient Crohn's disease database were reviewed.
RESULTS
All three patients treated by seton and fibrin glue recurred despite having relatively long tracts. Of six patients with infliximab treatment combined with a seton procedure, five patients had an improvement of their symptoms, but were not cured. Of eight patients with a transanal or endovaginal advancement flap techniques, three had successful closure, three eventually required a proctectomy, and two had a recurrent fistula without symptoms. Four (2 without any local treatments, and 2 with seton placement) of 16 patients who had a diverting stoma during treatment had successful closure. All proctectomy patients (n=8) had rectal involvement of Crohn's disease. Two patients who underwent a proctectomy with a presumptive diagnosis of ulcerative colitis and indeterminate colitis turned out to have Crohn's disease. Overall, except for the proctectomy patients, seven patients (54%) had successful closure, but six (four without symptoms, and two with symptoms) following a wide spectrum of treatments had recurrence after a mean follow-up of 44 months.
CONCLUSIONS
Combining different treatments for a rectovaginal fistula in Crohn's disease can be successful in a reasonable number of cases. The presence of uncontrolled perianal sepsis and/or complicated anorectal problems is likely to lead to a proctectomy.

Citations

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Guidelines for the Management of Crohn's Disease
Byong Duk Ye, Suk-Kyun Yang, Sung Jae Shin, Kang Moon Lee, Byung Ik Jang, Jae Hee Cheon, Chang Hwan Choi, Young-Ho Kim, Heeyoung Lee
Intestinal Research.2012; 10(1): 26. CrossRef
Guidelines for the Management of Crohn's Disease
Byong Duk Ye, Suk-Kyun Yang, Sung Jae Shin, Kang Moon Lee, Byung Ik Jang, Jae Hee Cheon, Chang Hwan Choi, Young-Ho Kim, Heeyoung Lee
The Korean Journal of Gastroenterology.2012; 59(2): 141. CrossRef
Long-term results in the treatment of fistula-in-ano with fibrin glue: a prospective study
Göktürk Maralcan, İlyas Başkonuş, Avni Gökalp, Ersin Borazan, Ahmet Balk
Journal of the Korean Surgical Society.2011; 81(3): 169. CrossRef

Early Experience with a Stapled TransAnal Rectal Resection for Obstructed Defecation Syndrome.: Shin, Jong Keun , Kwak, Chang Shin , Park, Jung Soo , Choi, Sung Il , Lee, Jae Bum , Park, Hyun Joo , Lee, So Jin , Lee, Doo Han , Kim, Do Sun; J Korean Soc Coloproctol. 2007;23(1):1-9.; DOI: https://doi.org/10.3393/jksc.2007.23.1.1

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Abstract PDF: PURPOSE
This study was designed to assess the early outcome of a stapled transanal rectal resection (STARR) in obstructed defecation syndrome (ODS) patients with rectocele and rectal intussusception.
METHODS
From January to December in 2005, 41 patients with the symptoms of obstructed defecation and the findings of rectocele and rectal intussusception in defecography, who failed in conservative management, were enrolled in this study. All patients underwent the STARR procedure. Preoperatively all patients received colonoscopy, a colon transit time test, cinedefecography, etc. The constipation score was evaluated by using the Cleveland Clinic Florida (CCF) constipation score preoperatively and at 1 month and 3 months after operation.
RESULTS
The mean age of the patients was 55.3 (19~76) years. There were three males and thirty-eight females. The mean operation time was 39.3 (25~80) minutes, and the mean hospital stay was 4.2 (4~6) days. Complications were fecal urgency in 9 cases (21.9%), which improved after 3 months, bleeding in 5 cases (12.2%), and anastomotic stenosis in 1 case (2.4%). At postoperative defecography, both intussusception and rectocele had disappeared in most patients. All constipation symptoms were significantly improved (P < 0.01). The mean CCF constipation score was 17.6 (11~24) preoperatively, and improved to 9.1 after 1 month and 8.2 after 3 months (P < 0.01). The overall patient satisfaction was graded as excellent, good, fairly good and poor in 19 cases (46.3%), 13 cases (31.7%), 4 cases (9.7%), and 5 cases (12.2%), respectively.
CONCLUSION
The STARR procedure seems to be a safe and effective procedure in ODS patients with rectocele and rectal intussusception. However, further study of the long-term results is required.

Decision of Salvage Treatment after Transanal Endoscopic Microsurgery: Clinical Experience on 36 Cases of Rectal Cancer.: Shin, Suk Hee , Han, Sang Ah , Park, Chi Min , Yun, Seong Hyeon , Lee, Woo Yong , Choi, Dong Wook , Chun, Hokyung; J Korean Soc Coloproctol. 2005;21(6):406-412.

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Abstract PDF: PURPOSE
Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation.
METHODS
From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin.
RESULTS
Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions.
CONCLUSIONS
In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion.

Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients.: Park, Chi Min , Jung, Keuk Won , Han, Sang Ah , Yun, Seong Hyeon , Lee, Woo Yong , Chun, HoKyung; J Korean Soc Coloproctol. 2005;21(5):293-299.

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Abstract PDF: PURPOSE
Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT.
METHODS
Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4~7 weeks following the completion of therapy.
RESULTS
The mean age was 54.9 (35~70) years and the median follow-up period was 23.0 (5~57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period.
CONCLUSIONS
TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer.

Comparison of Rectoanal Physiologic Changes and Treatment Results between Transanal Repair and Transanal Repair with Posterior Colporrhaphy in Patients with Rectocele.: Kim, Joo Hyung , Kwon, Young Min , Lee, Yong Pyo; J Korean Soc Coloproctol. 2004;20(2):86-92.

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Abstract PDF: PURPOSE
Rectoceles are often associated with anorectal symptoms. Various surgical techniques have been described to repair rectoceles, but the surgical results vary. The aim of this study was to compare transanal repair (TAR) and transanal repair with posterior colporrhaphy (TAR+PC).
METHODS
The records of 58 patients operated on during a 56-month period were reviewed. Of those 26 patients had a TAR, and 32 patients had a TAR+PC. Interviews and anorectal physiologic studies were performed preoperatively and postoperatively.
RESULTS
The recurrence rate after a TAR+PC was lower than the recurrence rate after a TAR (TAR 19.2% vs. TAR+PC 3.1%). The rectal sensation (sensory threshold: TAR 64.8+/-18.9 ml vs. TAR+PC 56.1+/-23.67 ml; earliest defecation urge: TAR 116.4+/-29.5 ml vs. TAR+PC 104.8+/-31.2 ml) was more improved after a TAR+PC.
CONCLUSIONS
A TAR+PC for treatment of a rectocele is safe and effectively corrects obstructed defecation. The improvement probably relates, at least in part, to rectal sensational factors other than the dimensions of the rectocele.

Transanal Posterior Anorectoplasty of Rectal Prolapse.: Kim, Jong Duck , Ye, Byung Kuk , Jo, Hong Jae , Oh, Nahm Gun; J Korean Soc Coloproctol. 2002;18(5):269-273.

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Abstract PDF: PURPOSE
Many different procedures for rectal prolapse have been described, but optional surgical treatment remains controversial. The aim of this report is to introduce an innovative and effective method of surgical treatment to restore anal continence and anatomic correction of rectal prolapse.
METHODS
Data were retrospectively collected and analyzed on 11 patients (7 male and 4 female) who underwent transanal posterior anorectoplasty for complete rectal prolapse between Jan. 1995 to Dec. 2000. This procedure is summarized to five steps as follows: 1. Partial resection of posterior rectal ampulla. 2. Longitudinal plication with posterior fixation. 3. Posterior levatorplasty. 4. One layer suture as longitudinal fashion. 5. Gant-Miwa operation-like procedure on anterior rectum.
RESULTS
There were no cases of postoperative infection and bleeding. There were no cases of recurrence of the rectal prolapse except 1 case of ant. mucosal prolapse which was successfully treated with one more Gant-Miwa operation-like procedure at postoperative 3 months. Fecal incontinence were in two cases at postoperative 12 months which were estimated as grade 2 by assessment of bowel function by Kirwan.
CONCLUSIONS
Although, the best operation for rectal prolapse remains controversial subject, authors believe that transanal posterior anorectoplasty should be considered as effective new surgical procedure for the treatment of rectal prolapse.

Therapeutic Results of Transanal Endoscopic Microsurgery and Radical Surgery for T1, T2 Rectal Cancer.: Lee, Doo Seok , Choi, Sung Il , Chang, Weon Young , Lee, Wooyong , Chun, HoKyung; J Korean Soc Coloproctol. 2002;18(4):240-245.

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Abstract PDF: PURPOSE
Transanal endoscopic microsurgery (TEM) has gained increasing acceptance as a treatment of choice for early rectal cancer. The purpose of this study was to compare the results of TEM and radical surgery in patients with T1 and T2 rectal cancer.
METHODS
From October 1994 to December 2000, 74 patients with T1 and T2 rectal adenocarcinoma treated with TEM were compared with 100 patients with T1N0M0 and T2N0M0 rectal adenocarcinoma treated with radical surgery. Retrospective analysis was made regarding to recurrence and survival rate. Neither group received adjuvant chemo-radiation. There was no significant difference in age, gender, tumor location and follow-up period between two groups, except tumor size.
RESULTS
Of 74 patients in TEM group, 52 patients were T1 (70.3%) and 22 patients were T2 (29.7%). Of 100 patients in radical surgery group, 17 patients were T1 (17.0%) and 83 patients were T2 (83.0%). Five-year local recurrence rates were 4.1% for T1, 19.5% for T2 after TEM, 0% for T1 and 9.4% for T2 after radical surgery. There was no statistical difference between T1 rectal cancer (P=0.95), but in T2 rectal cancer, it was higher after TEM than after radical surgery (P=0.04). Five-year disease free survival rates showed no statistical difference between two groups (TEM group: 95.9% for T1, 80.5% for T2, radical surgery group: 94.1% for T1, 83.3%for T2; P=0.35, P=0.12). Five-year survival rate were 100% for T1, 94.7% for T2 after TEM and 92.9% for T1, 96.1% for T2 after radical surgery. There were no significant statistical difference between two groups (P=0.07, P=0.48).
CONCLUSIONS
In T1 rectal cancer, there were no difference in recurrence and five-year survival rate between TEM and radical surgery group. In T2 rectal cancer, five-year survival rate showed no statistical difference between two groups, but TEM carried higher risk of local recurrence. Therefore careful selection of the patients is required for TEM and when proper muscle invasion is proven after TEM, further treatment should be considered.

Clinical Results of Transanal Endoscopic Microsurgery (TEM).: Chung, Jun Chul , Choi, Sung Il , Lee, Doo Suk , Chang, Weon Young , Noh, Sang Ik , Oh, So Hyang , Lee, Woo Yong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2002;18(2):104-109.

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Abstract PDF: PURPOSE
Local treatment of rectal tumors have become an alternative to the classic radical operation. However, conventional transanal procedures are limited to tumors located in the lower rectum and the precision of the excision is restricted by the limitation of the surgeon's visualization during the procedure. This report will present our surgical management and functional results after TEM, a new minimally invasive technique for the treatment of rectal tumors.
METHODS
From December 1994 to January 2000, 136 patients underwent TEM. All patients were evaluated preoperatively with sigmoidoscopy or colonoscopy with biopsy. The indications for TEM were benign rectal tumors and T1 and T2 malignant rectal tumors with well or moderately differentiation. All patients were followed up 1 month postoperatively and every 3 months thereafter.
RESULTS
The mean operation time was 56.5 minutes (25~150 minutes) and the mean postoperative hospital stay was 3.6 days (2~10 days). On the basis of the postoperative evaluations, 56 of the 136 patients proved to have benign tumors while the remaining 80 patients had malignant tumors. One hundred thirty five patients were removed with adequate resection margins. One patient had cancer cell involvement at the resection margin. There were no serious complications. After a mean observation time of 29 months (12~42 months), there were five noted recurrences. Functional results were excellent; 24 of the 136 patients complained of impaired continence or defecation disorders in a review one month postoperatively. These problems improved during the first 6 months after the surgery.
CONCLUSIONS
We feel that TEM is an adequate method for removal of benign rectal tumors, and properly selected early rectal cancers.

The Comparison between Transanal and Transvaginal Ultrasonography of Anal Sphincter in Normal Women.: Moon, Seong Pyo , Park, Sang Heon , Kim, Cheong Yong , Byun, Joo Nam; J Korean Soc Coloproctol. 2000;16(6):388-390.

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Abstract PDF: PURPOSE
The purpose of this study was to evaluate the normal value of the anal canal structures by transvaginal sonography in normal woman and compare this technique with the more commonly used transanal technique.
METHODS
Transvaginal ultrasonography was performed in 25 parous patients between 4th and 8th decade of age, using a Bruel and Kajer type-1890. This procedure was followed by transanal sonography using the same system. The thickness of mucosa and submucosa, internal and external anal sphincter and puborectalis muscle were measured by both methods.
RESULTS
The thickness of mucosa- submucosa, internal anal sphincter, external anal sphincter and puborectalis muscle by transvaginal sonography were 2.84 0.2 (2.6~3.0) mm, 2.98 0.4 (2.6~3.3) mm, 7.4 0.3 (7.1~7.7) mm, 7.5 0.5 (7.4~7.6) mm respectively(mean value standard deviation and range). The detection rate of external anal sphincter and puborectalis muscle by transvaginal sonography were between 55.5% (5/9) and 71.4% (5/7).
CONCLUSIONS
The thickness of internal anal sphincter was increased with age(p<0.05). The thickness of mucosa-submucosa, internal anal sphincter measured.

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