Transanal Endoscopic Microsurgery (TEM)
Introduction
TEM is used to treat a variety of anal and rectal conditions but most commonly is used to remove large polyps and small cancers. It provides a better approach than traditional per anal operations and in many cases removes the need for major abdominal surgery on the rectum.
Uses
Surgeons use their experience with clinical and endoscopic examination as well as the results of MRI and ultrasound scans of the rectum to determine whether or not certain anal and rectal problems are suitable for TEM surgery. Large polyps (often involving the full circumference of the bowel) and small rectal cancers may be safely removed intact with a wide margin of normal tissue. Areas of rectal scarring and narrowing, as well as the entire rectum if diseased, may be suitable for removal by TEM. All suitable conditions must be found within 20cm of the anal canal or less.
Technique
Under general anaesthesia a 4cm diameter scope is inserted into the anal canal and rectum. Through this carbon dioxide is pumped to allow a clear view of the bowel lining. Instruments are inserted to allow the surgeon to work with both hands to achieve precise dissection of the bowel wall and tissues beyond. Bleeding can be controlled, the specimen removed and the defect in the bowel wall closed with stitches.
Hospital Stay
Stay varies from overnight to three or four days according to the complexity of the operation and speed of recovery.
Complications
- Bleeding
- Infection and abscess formation
- Stricture (narrowing)
- Change in bowel habit
- Changes to continence (Usually temporary)
Information and Advice
Until the development of TEMS, many rectal polyps / growths were removed by major surgery. Transanal Endoscopic Microsurgery (TEMS) is a minimally invasive process that allows these rectal polyps / growths to be removed thereby avoiding major surgery. During the procedure a large complex instrument (TEMS scope) is inserted through the anus and the polyp is removed by passing very much smaller instruments into the scope to dissect the polyp out and remove it via the anus.
Once the polyp has been removed, a defect is left behind and this may or may not be closed with stitches. The stitches are held in place with small silver balls.
We usually advise that you stay in hospital for 2 days after the operation to monitor you for signs of bleeding or infection. Your temperature should be normal for 24 hours before going home. After the operation you may feel some rectal discomfort but you should not feel any pain unless the polyp that we removed was very near the anus itself. You should be able to go back on to a normal diet immediately after the operation. It is very important to avoid constipation by drinking plenty of fluid and taking adequate fibre. You may wish to soften the motion with Lactulose as a mild laxative. This can be bought over the counter at the chemist.
Following the operation rectal function may be somewhat disturbed but this should settle over the next few weeks. Because of the size of the instrument that is passed during the operation, the anal sphincter muscles may be stretched and this may lead to some leakage or incontinence. You may wish to wear a pad for protection until normal continence resumes as it does in virtually all cases. A little bit of bleeding is not unusual for the first few days after the operation but this should not be greater than a little spotting. If you see a lot of blood you should report immediately to your doctor. You may notice the little silver balls that were used to hold the stitches in place passed into the toilet. Infection is an unusual complication following TEMS but if you develop a temperature, pain in the abdomen or pelvis or discharge of pus through the anus then you should contact your doctor or myself immediately.
Other potential complications include bleeding, infection, incontinence, the need for major surgery with or without a stoma and the risk of finding cancer in an apparently benign polyp.
If you have any problems during your stay, please do not hesitate to get in touch with any member of my team. If you have problems after leaving hospital we would be very happy to deal with them if your local GP would like us to do so. In any event, you may always contact me through my secretary here at St. Richard’s on 01243 831593.