Transanal Endoscopic Microsurgical Excision
Transanal endoscopic microsurgical (TEM) excision is done to remove a benign polyp or cancerous growth from the rectum without removing the rectum and without an abdominal incision.
Some facts about Transanal Endoscopic Microsurgical Excision:
- Polyp Excision can simply and safely done at the time of your colonoscopy.
- Polyps are abnormal growths that rises from the lining of the rectum which is the last 12 inches of the large intestine.
- Polyps may be flat or develop on a stalk like broccoli and is called a pedunculated polyp.
- Although most polyps are asymptomatic and never turn into cancer, a small percentage of polyps can slowly grow and develop into rectal cancer over 8-10 years.
- The presence of dysplasia or pre-cancerous changes, the type of polyp, and the size of the polyp are the factors for malignant potential of polyps.
- Symptoms of rectal polyps include rectal bleeding, bloody stools, mass, mucous discharge, protrusion from the anus, and abdominal pain.
- A change in bowel habits may also occur including constipation and diarrhea.
- Digital rectal exam or flexible sigmoidoscopy are usually done to diagnose rectal polyps.
- Rectal polyps are also diagnosed either by x-ray with a virtual colonoscopy or barium enema or by looking at the colonic lining directly with a colonoscopy
- A polyp tissue can be examined by a pathologist under a microscope to determine whether it is potentially cancerous.
- People with a history of polyps should have regular exams by a physician specially trained to treat diseases of the colon and rectum as they have an increased risk of developing polyps again in their lifetime.
Preparation for Transanal Endoscopic Microsurgical Excision:
- You need to stop taking medications that may thin your blood, such as ibuprofen (Advil) or aspirin a few weeks before your surgery.
- You should stop smoking temporarily or permanently if you’re ready to quit as smoking can make it harder for your body to heal after surgery.
- You need to wait for any existing flu, fever, or cold to break.
- Most of your diet should be replaced with liquids and laxatives should be taken to empty your bowels.
- You may also need to only drink water or other clear liquids, such as broth or juice in the 24 hours before your surgery.
- Do not eat or drink anything for up to 12 before the surgery.
- Any medications that your surgeon gives you should be taken right before surgery.
Procedure for Transanal Endoscopic Microsurgical Excision:
- A 20 cm-long proctoscope which is an instrument used for dilating and visually inspecting the rectum is placed through the anus during the TEM procedure.
- This allows the surgeon to visualize and remove the polyp or cancerous growth.
- TEM is a less invasive method than traditional procedures used to remove benign polyps or cancerous rectal tumors.
- The diseased portion of the bowel can be removed surgically when the polyps are too large or can't be removed safely during screening .
- Complications and side effects associated with taking out the entire rectum can be reduced by TEM.
- Most of the patient experience minimal pain and can be back to normal activities in two to three days.
- TEM excision can be used for removal of benign polyps and early cancers that would otherwise require an abdominal surgery and removal of the rectum.
- It may be considered to remove more advanced cancers in combination with radiation for elderly or infirm patients.
