Transanal Excision Surgery Bannerghatta | Transanal Total Mesorectal Excision Jayanagar

Transanal Excision Surgery

Transanal excision surgery also called local transanal resection, is performed for the treatment of early-stage/stage I rectal or colorectal cancer. This surgery aims to preserve the anal sphincter in rectal cancer patients as it is a sphincter-sparing surgery. The sphincter is a group of muscles in your anus that contracts and relaxes to regulate your bowel movements.

Most of the people who undergo a transanal excision surgery do not require a colostomy bag (a plastic bag that collects faecal waste from your digestive tract through an opening in the abdominal wall called a stoma).

What are the Indications for Transanal Excision Surgery?

You will be recommended a transanal excision surgery if you are diagnosed with rectal cancer that fulfils the following criteria:

The tumour size is <3 cm
The tumour occupies less than one-third of the circumference of the rectum
The tumour is not deep and is located on the surface of the rectum
Cancer has not spread to the anus and sphincter
The surrounding lymph nodes are not enlarged/affected

Preparation for Transanal Excision Surgery

You will be given an oral bowel preparation 24 hours before your surgery to clear your bowels of faecal matter, so your surgeon has a clear view to work.

You would be given antibiotics to minimize the risk of infection.
Anticoagulants, commonly known as blood thinners, would also be discontinued.
You should consume only clear liquids such as water, lemonade, or energy drinks before your surgery.

Surgical Procedure of Transanal Excision

You will be administered a local or general anaesthesia based on your surgeon’s discretion.

You will be placed on an operating table in a lithotomy position (supine position with your legs raised slightly upwards) using adjustable stirrups if your tumour is located towards the posterior side.
Alternatively, you will be placed in a prone jackknife position where you must lie on your stomach with the hips raised and the head and legs flexed at a lower angle, for lateral and anterior tumours.
An anal retractor will be placed at the anus to help in visualization.
Your colorectal surgeon will insert surgical instruments into the rectum via the anus.
The layers of the rectal wall are incised (cut) to access the tumour and it is removed along with some surrounding rectal tissues.
The anus, the sphincter, and the surrounding lymph nodes remain intact.
The remaining healthy ends of the rectum are sutured together.
The surgical instruments are removed carefully.

Some people may be given radiation and/or chemotherapy treatment after the surgery.

Post-operative Care after Transanal Excision Surgery

You will be discharged from the hospital within 24 hours after your surgery.

You may resume your regular diet and functional activities after your discharge.
You will be trained on pelvic floor exercises to strengthen your abdominal and rectal muscles.
Follow the general instructions given by your surgeon such as avoiding heavy lifting and exerting excessive strain while passing stools.

Risks and Complications of Transanal Excision Surgery

Transanal excision surgery is a relatively safe surgical procedure with minimal complexity. However, it may be associated with the following risks:

Postoperative bleeding
Fever
Rectal pain
Infection
Injury to the surrounding blood vessels

What are the Advantages of Transanal Excision Surgery?

Transanal excision surgery offers many advantages such as:

Rapid recovery
Shorter hospital stay
Low mortality rate
Reduced chances of recurrence
Minimizes risk of sphincter injury
Improves the quality of life post-surgery
Improves survival rate
Avoids the need for a stoma and the need to wear a permanent colostomy bag

Transanal Total Mesorectal Excision (TaTME)

Transanal total mesorectal excision (TaTME) is an advanced surgical technique for the treatment of rectal cancers. It involves complete removal of the tumour, most of the rectum, and the mesorectum. The mesorectum refers to the fatty tissues around the rectum which contain lymph nodes and blood vessels. Removing the mesorectum minimizes the risk of cancer spread and recurrence.

Transanal total mesorectal excision is performed using a combination of a laparoscopic approach (through the lower abdomen) and a trans-anal approach (through the anus) which provides better access to the surgical site.

Indications for Transanal Total Mesorectal Excision (TaTME)

Transanal total mesorectal excision (TaTME) is recommended for people with low rectal tumours which are difficult to access through an abdominal approach and result in a greater risk of undergoing a permanent colostomy (need for a stool bag). It is also recommended for those who are obese and those with a narrow pelvic structure (mostly men).

Pre-Operative Preparation for Transanal Total Mesorectal Excision (TaTME)

You will be given an oral bowel preparation 24 hours before your surgery to clear your bowels of faecal matter, so your surgeon has a clear view to work. You should consume only clear liquids such as water, lemonade, or energy drinks before your surgery. Antibiotics are administered to minimize the risk of infection.

Surgical Procedure of Transanal Total Mesorectal Excision (TaTME)

You will be administered general anaesthesia and placed on an operating table in lithotomy position (on your back with your legs bent and raised in stirrups).

A retractor is used to open the anus.
A surgical device is passed through the anus.
A few small incisions are made in your abdomen to facilitate the insertion of the laparoscope and the surgical instruments.
The surgical device and instruments are used to cut and remove the rectum along with the tumour and surrounding mesorectum. These tissues are usually taken out through the anus.
The end of the colon (large intestine) is sutured or stapled to the anus.
A small temporary opening called a stoma is created in your abdomen and the colon is connected to it. This facilitates excretion of body wastes allowing the reattached colon to heal. You will be required to wear a bag outside your abdomen to collect stools during this time.
If removal of the tumour requires removal of the anus so that the colon cannot be reattached, a permanent colostomy will be necessary.
At the end of the procedure, the incisions are closed.

Post-operative Care after Transanal Total Mesorectal Excision (TaTME)

You will be required to stay in the hospital for a few days to a week after your surgery to monitor your recovery.

You will initially be put on a liquid diet which will be gradually replaced with solid food.
You may require some time to regain your bowel function, after which you can resume oral consumption.
You will be recommended to move around as soon as possible to regain strength.
You will be trained on pelvic floor exercises to strengthen your abdominal and rectal muscles.

Risks and Complications of Transanal Total Mesorectal Excision (TaTME)

Transanal total mesorectal excision (TaTME) is a relatively complicated procedure compared to conventional colectomy (colon removal) surgeries. It may be associated with the following risks:

Anastomotic leakage through where the colon and anus are reattached
Postoperative bleeding
Infection
Injury to the surrounding blood vessels

Benefits/Advantages of Transanal Total Mesorectal Excision (TaTME)

Compared to conventional colon cancer surgery, transanal total mesorectal excision (TaTME) offers the following benefits:

The surgeon can view the internal organs better.
The surgical instruments can be operated with more precision.
The distal margin, i.e., healthy tissue below the tumour, is more accurately determined.
Reduced risk of recurrence as the cancer is more completely removed
Shorter hospital stay
Quicker postoperative recovery

Transanal Endoscopic Microsurgery (TEMS)

Transanal endoscopic microsurgery (TEMS) is a minimally invasive procedure for the treatment of benign anal and rectal tumours. It is performed through the insertion of a specially designed microscope called an endoscope and surgical instruments via the anus and does not require incisions(cuts) in your abdomen. TEMS offers a quicker recovery and minimal postoperative pain compared to abdominal surgery. It is recommended for the removal of rectal polyps and early-stage rectal cancer.

What are the Indications for Transanal Endoscopic Microsurgery (TEMS)?

Transanal endoscopic microsurgery (TEMS) is a superior alternative to a major abdominal surgery. It is usually recommended for people who are elderly, have comorbidities and cannot undergo a major abdominal surgery.

You will be recommended a transanal endoscopic microsurgery (TEMS) if you are diagnosed with large rectal polyps or early stage rectal cancer.

Pre-Surgical Preparation for Transanal Endoscopic Microsurgery (TEMS)

You will be given an oral bowel preparation 24 hours before TEMS to clear your bowels of faecal matter, so your surgeon has a clear view to work. You should consume only clear liquids such as water or lemonade before the procedure.

Procedure of Transanal Endoscopic Microsurgery (TEMS)

The procedure for transanal endoscopic microsurgery (TEMS) involves the following steps:

You will be administered general anaesthesia.
You will be placed on an operating table in a lithotomy position (supine position with your legs raised slightly upwards) using adjustable stirrups.
An anal retractor will be placed at the anus to help in visualization.
Your colorectal surgeon will insert a proctoscope (an inspection device with an attached camera for viewing) into the rectum via the anus.
The proctoscope is positioned over the lesion to be removed.
Your colorectal surgeon may infuse gas into the rectum to expand it to get a better internal view.
The rectal lesion is incised (cut) and the remaining space is sutured.
Sometimes the space left after removal of the tumour or polyp may be left untouched for natural healing.
The surgical instruments are removed carefully.

Post-operative Care after Transanal Endoscopic Microsurgery (TEMS)

You will be discharged from the hospital within 24 hours after your surgery.

You can resume your regular diet and functional activities after your discharge.
You would be given antibiotics to minimize the risk of infection and pain relief medications for discomfort.
You may have liquid stools for a few days after TEMS that will gradually become formed stools.
Avoid driving the first week after TEMS.
Follow the general instructions given by your surgeon such as avoiding heavy lifting and exerting excessive strain while passing stools.
You may practice pelvic floor exercises to strengthen your pelvic and rectal muscles.