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. 2023 Jan 6;408(1):11.
doi: 10.1007/s00423-022-02745-9.

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

J A Gracia  1   2 , M Elia  1   2 , E Cordoba  1   2 , A Gonzalo  1   2 , J M Ramirez  3   4
Affiliations

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

J A Gracia et al. Langenbecks Arch Surg. .

Erratum in

Abstract

Purpose: After a full-thickness total wall excision of a rectal tumor, suturing the defect is generally recommended. Recently, due to various contradictory studies, there is a trend to leave the defects open. Therefore, this study aimed to determine whether leaving the defect open is an adequate management strategy compared with suturing it closed based on postoperative outcomes and recurrences.

Methods: A retrospective review of our prospectively maintained database was conducted. Adult patients who underwent transanal surgery for rectal neoplasm in our institution from 1997 to 2019 were analyzed. Patients were divided into two groups: sutured (group A) or unsutured (group B) rectal defect. The primary outcomes were morbidity (early and late) and recurrence.

Results: In total, 404 (239 men) patients were analyzed, 143 (35.4%) from group A and 261 (64.6%) from group B. No differences were observed in tumor size, distance from the anal verge or operation time. The overall incidence of complications was significantly higher in patients from group B, which nearly double the rate of group A. With a mean follow-up of 58 (range, 12-96) months, seven patients presented with a rectal stricture, all of them from group B.

Conclusions: We acknowledge the occasional impossibility of closing the defect in patients who undergo local excision; however, when it is possible, the present data suggest that there may be advantages to suturing the defect closed.

Keywords: Local surgery; Rectal cancer; Rectal tumor; Transanal surgery.

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Conflict of interest statement

JMR shares a patent for a rectoscope by Richard Wolf, and JAG, ME, EC, and AG have no conflicts of interest to disclose.

References

    1. Ramirez JM, Aguilella V, Gracia JA, Ortego J, Escudero P, Valencia J, Esco R, Martinez M. Local full-thickness excision as first line treatment for sessile rectal adenomas long-term results. Ann Surg. 2009;249:225–228. doi: 10.1097/SLA.0b013e318190496f. - DOI - PubMed
    1. Mainprize KS, Mortensen NJ, Warren BF. Early colorectal cancer: recognition, classification and treatment. Br J Surg. 1998;85:469–476. doi: 10.1046/j.1365-2168.1998.00692.x. - DOI - PubMed
    1. Ramirez JM, Aguilella V, Valencia J, Ortego J, Gracia JA, Escudero P, Esco R, Martinez M. Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results. Int J Colorectal Dis. 2011;26:437–443. doi: 10.1007/s00384-011-1132-9. - DOI - PubMed
    1. Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. Endoscopic surgery in the rectum. Endoscopy. 1985;17:31–35. doi: 10.1055/s-2007-1018451. - DOI - PubMed
    1. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2010;24:2200–2205. doi: 10.1007/s00464-010-0927-z. - DOI - PubMed

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