This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Factors influencing selection for a day‐case or 23‐h stay procedure in transanal endoscopic microsurgery. BJS 2010; 97: 410-414.
Published: 22nd January 2010
Authors: S. J. Ford, J. M. D. Wheeler, N. R. Borley
Background
Transanal endoscopic microsurgery (TEMS) is an alternative to radical resection of the rectum for benign lesions and early rectal cancer. This study aimed to identify whether day‐case TEMS is safe and which factors dictate patient suitability and length of stay (LOS).
Method
Details of patients undergoing TEMS resection were retrieved from a tertiary referral prospective database.
Results
Of 96 patients, 46 (48 per cent) were day cases, 24 (25 per cent) had a 23‐h stay and 26 (27 per cent) were inpatients. The frequency of day‐case surgery increased significantly over the study interval (P = 0·050). Distance of the lesion from the anorectal junction, malignant potential and travel distance had no bearing on LOS. Older age (P = 0·004) and duration of surgery (P = 0·002) correlated significantly with increased LOS. Lesions covering one quadrant involved a significantly shorter stay than those covering two or more quadrants (P = 0·002). Maximum diameter (mean 5·7 cm) was strongly related to LOS (P = 0·009). Day‐case and 23‐h stay patients had a significantly higher proportion of lower‐risk lesions (P = 0·001).
Conclusion
High‐volume day‐case TEMS appears safe, even when long travel distances are involved. With advances in practice and procedural safety, traditional risk factors may not be as important as currently thought. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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