Novosti
Khirurgii

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Year 2017 Vol. 25 No 5

EXCHANGE OF EXPERIENCE

K.N.ZHANDAROV1, S.V.ZHDONETS1, K.S.BELYUK2, V.A.MITSKEVICH1, YU.F.PAKULNEVICH1

TRANSANAL ENDOSCOPIC MICROSURGERY OF RECTAL TUMORS

ME “Grodno Regional Clinical hospital” 1,
EE “Grodno State Medical University” 2, Grodno,
The Republic of Belarus

Objectives. To improve the methods of transanal endoscopic microsurgery (TEM) of the rectal neoplasms increasing the radicalism of surgical treatment and to reduce the incidence of complications and recurrences.
Methods. The analysis of the results of transanal surgeries (n=44) performed due to the large villous benign tumors and polyps with a wide base (39), rectal cancer (n=4; T1-T2NxMo) on the background of recurrent malignant polyp has been conducted. Transanal total mesorectumectomy (n=1) was performed in combination with laparoscopy and sigmorectal anastomosis.
Results. No intraoperative complications were registered. The postoperative bed-day was 6.8±1.2 days in the study group. In the early incisional period, after removing the neoplasms the defects in the rectal wall was closed with suture, the evidence of edema in 33 (76%) patients at the site of wall closure (which had gone down completely by the 7th-8th days) was detected during control rectoscopy. 4 patients who had been operated on villous tumors of low localization, the dehiscence of intestinal wall suture had been already registered by the 2nd-4th days afterward.
In the long-term postoperative period, complications requiring surgical correction appeared in 3 (6.8%) patients (cicatricial stenosis-1, tumor recurrence-2), who have been successfully performed the repeated interventions with the use of TEM. Within 2 years no signs of both local recurrent and metastatic disease spread to the lungs and to the liver were revealed in the patient after transanal mesorectumectomy with laparoscopy. In the remaining 31 (70.5%) patients, the outcomes of surgical treatment are regarded as good and satisfactory.
Conclusion. The transanal endoscopic microsurgery is accepted as an effective alternative method for large rectal adenomas of any type of growth. Minimally invasive surgeries with the SILS system are possible to perfom throughout the rectum; since they possess a number of advantages and there is minimal risk of complications and recurrences.

Keywords: transanal endoscopic microsurgery, SILS-port, rectal tumors, rectoscopy, complications, recurrences, mortality
p. 543-552 of the original issue
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Address for correspondence:
230006, Republic of Belarus,
Grodno, Gorkogo str., 80,
EE «Grodno state medical university»,
Department of Surgical Diseases ¹1,
tel. mob.: 375 29 78-19-403,
e-mail: BelyukKS@yandex.ru,
Konstantin S. Belyuk
Information about the authors:
Zhandarov K.N. MD, Professor.
Zhdonets S.V. Physician, ME “Grodno Regional Clinical hospital”.
Belyuk K.S. PhD, Assistant of the Surgical Diseases Department N1, “Grodno State Medical University”.
Mitskevich V.A. Physician, ME “Grodno Regional Clinical hospital”.
Pakulnevich Y.F. Physician, Head of Proctology and Purulent Surgery Department, ME “Grodno Regional Clinical hospital”.
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