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Transanal endoscopic microsurgery (TEM)

Follow-up

The patient may begin to drink, eat and mobilize immediately after surgery. The catheter is removed as soon as the patient is mobilized and no later than the first postoperative day.

Oral analgesics is administered if required. There is usually minimal pain associated with the postoperative phase, but sutures in and close to the dentate line may be painful.

Patients are usually discharged on the first postoperative day. For very large resections or increased risk of infection the patient stays hospitalized for three-four days for observation.

Complications

  • Serious complications after TEM are rare.
  • Moderate fever (up to 38.5 ° C) and CRP increase to 200 is normal and does not indicate a complication.
  • Infection originating from the perirectal pocket that appears after suture of the intestinal wall may occur. An abscess usually drains itself through the sutures and antibiotics for some days are sufficient treatment. In rare cases (1-2 %), the patient gets a serious perirectal infection, possibly with sepsis.
  • Postoperative bleeding in the form of blood seepage is common. Hematoma in perirectal pocket often leads to infection. In some cases (about 5 %) a major bleeding may occur 6-10 days after surgery and a doctor should be consulted.The bleeding usually stops spontaneously.
  • Postoperative perforation of the intestine to free abdominal cavity is very rare. The condition usually requires reoperation and construction of a stoma.

Control for TEM for cancer

The patients should have follow- up controls at the surgical ward which carried out the operation.

There should be controls at least every six months for three years. Thereafter annually up to the fifth follow-up year. At every control a rectal examination, endoscopy and possibly rectal ultrasound are performed. This is sufficient if R0 resection with good margins at T1 sm1 is performed.

If a TEM is performed as a compromise at deep T1 or T2 tumor, and new treatment is relevant in case of local-regional recurrence, a control with MRI of the pelvis should be considered, particularly if the tumor was above the level that can be reached with the fingers during exploration. Additionally the CEA may be controlled. CT for detection of distant metastases may be considered individually.

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