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Transanal Endoscopic Microsurgery

Overview

This procedure, sometimes simply referred to by the initials 'TEM', is an alternative approach to remove polyps from the rectum. Normally done during a colonoscopy, transanal endoscopic microsurgery is used where polyps cannot be removed during a colonoscopy, due to their shape or size - flat polyps and large polyps can sometimes not be removed during a regular colonoscopy procedure. It is only used for benign (ie non- cancerous) polyps and is not used to treat rectal cancer.

How should I prepare for surgery?

The day before admission we will contact you to confirm admission time and to give you instructions regarding any fasting requirements for the procedure. You should bring any x-rays in with you (and ensure you take them with you when you are discharged). Also bring any current medication in with you to the hospital.

For day procedures you should not drive yourself home when you are discharged – please ensure you have made other transport arrangements.

If you smoke, you should reduce smoking before your procedure. Our strong recommendation is that you give up entirely at least 6 weeks before the procedure, or at least one week beforehand. Smoking greatly increases the possibility of chest infection and hampers natural wound healing.

In the case of major surgery, please inform Dr White's team if you take:

  • Warfarin.
  • Aspirin.
  • Plavix.
  • Anti-inflammatory medication.

We will need to discuss these medications with you prior to your surgery.

Dr White will provide you with a full set of pre-operative instructions for your specific surgery well ahead of the day of surgery.

What is involved in the procedure?

Surgery takes 45-90 minutes and takes place under general anaesthesia. First the rectum is pumped with a small quantity of CO2 and then endoscopic instruments are introduced via the anal opening. Once the polyp/s have been surgically removed the section of the rectum is repaired with stitches.

As with a colonoscopy, any tissue or polyps removed are sent to pathology for analysis to determine if there are any cancerous or pre-cancerous cells present. Around 10% of polyps are found to have some cancerous cells, and in these cases further surgery may be required.

Recovery Guidelines

Patients undergoing transanal endoscopic microsurgery are generally able to go home the following day. There is generally little post-operative pain associated with the procedure.

It is not uncommon for patients to have more frequent or urgent bowel motions or looser stools for 10-14 days after surgery. Very occasionally there may also be temporary minor faecal incontinence.

Surgical Risks

All types of surgery are subject to the following risks, which are rare, but can occur:

  • Allergic reaction to medication / anaesthetic.
  • Bleeding.
  • Difficulty breathing.
  • Infection.

Risks relating to this specific procedure include:

  • Inflammation of the pelvis.
  • Faecal incontinence (generally only temporary).
  • Formation of blood clots (such as deep vein thrombosis in the veins of the legs or pulmonary emboli in the lungs).

In some cases, this procedure may need to be converted to open surgery. If this is likely to be the case Dr White will discuss this with you prior to surgery.

When to contact Dr White

Most surgical procedures are uneventful, with minimal complications. However, you need to be aware of the following symptoms as they may indicate a developing serious complication...

  • Fever.
  • Excess bleeding.
  • Difficulty urinating.
  • Severe or increasing pain.

If you experience any of these symptoms or have any concerns after your surgery, please contact the rooms on 07 5598 0955 for advice.

A post operative appointment will be made for you before you are discharged from hospital. If you are discharged on a weekend, after normal surgery hours or it is not clear what follow up appointments are required, then contact the rooms the next working day to make an appointment.

If you experience any of the following you should contact Dr White immediately (or your doctor / GP or out of hours go to your local emergency department):

  • Difficulty urinating.
  • Bleeding (in excess of that described above).
  • High temperature / fever.
  • Pain that is severe or getting worse.