Skip to main content

Advertisement

SpringerLink
Log in

Fecal incontinence after transanal endoscopic microsurgery

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Transanal endoscopic microsurgery (TEM) procedure could potentially influence the development of fecal incontinence later in life. The aim of our study was to assess long-term functional outcomes after TEM and to determine possible variables related to incontinence.

Methods

Patients, enrolled in a prospectively collected TEM operation database, were interviewed using a postal questionnaire. The questionnaire consisted of EuroQol (EQ)-5D-5L quality of life questionnaire, Wexner fecal incontinence grading scale, and additional questions about other perianal operations and obstetric history for women. We divided patients into two groups: no or minor fecal incontinence (Wexner score of 2 and less) and non-minor incontinence (Wexner score of 3 or more).

Results

One hundred thirty-two patients were included in the study. Patients’ median follow-up time was 96 (12–168) months from their operation. Thirty-eight patients (28.8%) reported Wexner score of 3 or more, and they reported significantly worse quality of life in all tested life spheres. They were older at the time of the operation (63 (18–82) vs. 68 (50–89) years; p = 0.004), underwent longer operations (50 (10–140) vs. 60 (15–210) min; p = 0.017), and more often were operated for malignant lesions (17 (18.3%) vs. 14 (36.8%); p = 0.040). Older age at the time of operation was an independent risk factor in multivariate model (OR 1.057, 95% CI 1.010–1.106; p = 0.016).

Conclusions

Fecal incontinence after TEM is more common than thought previously, resulting in significantly impaired quality of life. Older age at the time of operation was an independent risk factor for developing significant fecal incontinence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Restivo A, Zorcolo L, D’Alia G, Cocco F, Cossu A, Scintu F, Casula G (2016) Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Color Dis 31:257–266. https://doi.org/10.1007/s00384-015-2371-y

    Article  Google Scholar 

  2. Mentges B, Buess G, Effinger G, Manncke K, Becker HD (1997) Indications and results of local treatment of rectal cancer. Br J Surg 84:348–351

    Article  CAS  PubMed  Google Scholar 

  3. Marques CFS, Nahas CSR, Ribeiro U, Bustamante LA, Pinto RA, Mory EK, Cecconello I, Nahas SC (2016) Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course. Int J Color Dis 31:833–841. https://doi.org/10.1007/s00384-016-2527-4

    Article  Google Scholar 

  4. Wang H-S, Lin J-K, Yang S-H, Jiang J-K, Chen W-S, Lin T-C (2003) Prospective study of the functional results of transanal endoscopic microsurgery. Hepato-Gastroenterology 50:1376–1380

    PubMed  Google Scholar 

  5. Cataldo PAMD, O’Brien SMA, Osler TMD (2005) Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum 48:1366–1371. https://doi.org/10.1007/s10350-005-0031-y

    Article  PubMed  Google Scholar 

  6. Kennedy ML, Lubowski DZ, King DW (2002) Transanal endoscopic microsurgery excision. Dis Colon Rectum 45:601–604

    Article  CAS  PubMed  Google Scholar 

  7. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736. https://doi.org/10.1007/s11136-011-9903-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  9. Hayden DM, Weiss EG (2011) Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg 24:64–70. https://doi.org/10.1055/s-0031-1272825

    Article  PubMed  PubMed Central  Google Scholar 

  10. Planting A, Phang T, Raval M, Brown C (2013) Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life. Can J Surg 56:243–248. https://doi.org/10.1503/cjs.028411

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ng K-S, Sivakumaran Y, Nassar N, Gladman MA (2015) Fecal incontinence: community prevalence and associated factors—a systematic review. Dis Colon Rectum 58:1194–1209. https://doi.org/10.1097/DCR.0000000000000514

    Article  PubMed  Google Scholar 

  12. Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A, Weidner A, Weinstein M, Ye W; Pelvic Floor Disorders Network (2009) Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 137(2):512–7, 517.e1–2

  13. Melville JL, Fan MY, Newton K, Fenner D (2005) Fecal incontinence in US women: a population-based study. Am J Obstet Gynecol 193(6):2071–2076

    Article  PubMed  Google Scholar 

  14. Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643. https://doi.org/10.1002/bjs.7584

    Article  CAS  PubMed  Google Scholar 

  15. Hompes R, Ashraf SQ, Gosselink MP, van Dongen KW, Mortensen NJ, Lindsey I, Cunningham C (2015) Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Color Dis 17:O54–O61. https://doi.org/10.1111/codi.12858

    Article  CAS  Google Scholar 

  16. Herman RM, Richter P, Wałęga P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Color Dis 16:370–376. https://doi.org/10.1007/s003840100325

    Article  CAS  Google Scholar 

  17. Doornebosch PG, Gosselink MP, Neijenhuis PA, Schouten WR, Tollenaar RAEM, de Graaf EJR (2008) Impact of transanal endoscopic microsurgery on functional outcome and quality of life. Int J Color Dis 23:709–713. https://doi.org/10.1007/s00384-008-0442-z

    Article  CAS  Google Scholar 

  18. Kreis ME, Jehle EC, Haug V, Manncke K, Buess GF, Becker HD, Starlinger MJ (1996) Functional results after transanal endoscopic microsurgery. Dis Colon rectum 39:1116–1121

    Article  CAS  PubMed  Google Scholar 

  19. Oor JE, Roks DJ, Broeders JA, Hazebroek EJ, Gooszen HG (2017) Seventeen-year outcome of a randomized clinical trial comparing laparoscopic and conventional Nissen fundoplication: a plea for patient counseling and clarification. Ann Surg 266:23–28. https://doi.org/10.1097/SLA.0000000000002106

    Article  PubMed  Google Scholar 

  20. Liot E, Bréguet R, Piguet V, Ris F, Volonté F, Morel P (2017) Evaluation of port site hernias, chronic pain and recurrence rates after laparoscopic ventral hernia repair: a monocentric long-term study. Hernia 21:917–923. https://doi.org/10.1007/s10029-017-1663-2

    Article  PubMed  Google Scholar 

  21. Jeansonne LO, White BC, Pilger KE, Shane MD, Zagorski S, Davis SS, Hunter JG, Lin E, Smith CD (2007) Ten-year follow-up of laparoscopic Heller myotomy for achalasia shows durability. Surg Endosc 21:1498–1502. https://doi.org/10.1007/s00464-007-9500-9

    Article  PubMed  Google Scholar 

  22. Nevler A (2014) The epidemiology of anal incontinence and symptom severity scoring. Gastroenterol Rep 2:79–84. https://doi.org/10.1093/gastro/gou005

    Article  Google Scholar 

  23. Koedam TWA, van Ramshorst GH, Deijen CL, Elfrink AKE, Meijerink WJHJ, Bonjer HJ, Sietses C, Tuynman JB (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctology 21:25–33. https://doi.org/10.1007/s10151-016-1570-z

    Article  CAS  Google Scholar 

  24. Konsten J, Baeten C (2000) Hemorrhoidectomy vs. Lord’s method. Dis Colon Rectum 43:503–506

    Article  CAS  PubMed  Google Scholar 

  25. Hurlstone DP, Sanders DS, Cross SS, George R, Shorthouse AJ, Brown S (2005) A prospective analysis of extended endoscopic mucosal resection for large rectal villous adenomas: an alternative technique to transanal endoscopic microsurgery. Color Dis 7:339–344

    Article  CAS  Google Scholar 

  26. Iizuka H, Okamura S, Onozato Y, Ishihara H, Kakizaki S, Mori M (2009) Endoscopic submucosal dissection for colorectal tumors. Gastroentérologie Clin Biol 33:1004–1011. https://doi.org/10.1016/j.gcb.2009.02.039

    Article  CAS  Google Scholar 

  27. Barendse RM, Oors JM, de Graaf EJR, Bemelman WA, Fockens P, Dekker E, Smout AJPM (2013) The effect of endoscopic mucosal resection and transanal endoscopic microsurgery on anorectal function. Color Dis 15:e534–e541. https://doi.org/10.1111/codi.12311

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Matas Jakubauskas, Valdemaras Jotautas, Eligijus Poskus, Saulius Mikalauskas, Gintare Valeikaite-Tauginiene, Kestutis Strupas & Tomas Poskus

  2. Center of Abdominal Surgery, Vilnius University Hospital “Santaros Klinikos”, Santariskiu Str. 2, LT-08661, Vilnius, Lithuania

    Valdemaras Jotautas, Eligijus Poskus, Saulius Mikalauskas, Gintare Valeikaite-Tauginiene, Kestutis Strupas & Tomas Poskus

Authors
  1. Matas Jakubauskas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valdemaras Jotautas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eligijus Poskus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saulius Mikalauskas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gintare Valeikaite-Tauginiene
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kestutis Strupas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomas Poskus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomas Poskus.

Ethics declarations

Statement on human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflicts of interest.

Electronic supplementary material

ESM 1

(SAV 7 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jakubauskas, M., Jotautas, V., Poskus, E. et al. Fecal incontinence after transanal endoscopic microsurgery. Int J Colorectal Dis 33, 467–472 (2018). https://doi.org/10.1007/s00384-018-2983-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-2983-0

Keywords

Search

Navigation