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LOCAL RADICAL TREATMENT OF

PATHOLOGICAL LESIONS OF THE

RECTUM WITH MINIMALLY INVASIVE

SURGICAL APPROACHES

Dejan Stevanović
1, 2
Nebojša Mitrović in the rectum. In all patients, the changes were
1, 2
Damir Jašarović localized in the rectum from 5 to 15 cm from the
1, 2
Marija Nikolić anocutaneous line in the TAMIS group and from 0 to 6
2
Darko Bajec cm in the TAE group. Pathological changes could not
2
Aleksandar Ivković be resected by endoscopic polypectomy.
2
Branko Lukić 2
Results: The average duration of the operations
1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
was longer in the TAMIS group and amounted to
2 Department of Surgery, Clinical Hospital Center Zemun, Belgrade,
Serbiaa 45 minutes, while the operations lasted an average
of 20 minutes in the TAE group. During the surgical
Corresponding author: procedure, mucosectomy is most often performed,
followed by resection of the full thickness of the
Prof. dr Dejan Stevanović
rectal wall, and resection of the rectal wall with part
Klinika za hirurgiju, Kliničko bolnički centar Zemun, Vukova 9, of the mesorectal tissue was performed the least
Beograd, Srbija
frequently in both analyzed groups. In 3 patients we
drdejanstevanovic@gmail.com had preparation fragmentation, and in 1 case we had
positive margins by histopathological postoperative
analysis in the TAMIS group. In the TAE group, we
Abstract had one patient with preparation fragmentation and
a positive margin. Patients with a positive margin in
Introduction: The most common pathological changes both the TAE and TAMIS groups belonged to villous
treated in the rectum are neoplastic polyps (villous, adenomas with a high degree of dysplasia. The final
tubular, and tubulovillous adenomas) and rectal HP finding in both groups most often spoke in favor
adenocarcinomas. Until now, precancerous lesions of the of tubulovillous adenoma with a low to medium
type of neoplastic polyps have been treated with a local degree of dysplasia. In both groups, we had 2 cases of
approach, and patients with advanced cancers have been early intramucosal carcinoma T1 stage.
operated on with a radical surgical intervention, either
classically or laparoscopically. Discussion: The postoperative period of
hospitalization is shorter in TAE compared to TAMIS
Aim: In this paper, we will show the advantages and (1.3 days compared to 1.8 days). We had no serious
disadvantages of certain local surgical approaches to postoperative complications in any of the observed
pathological changes in the rectum. groups. In one case, we had postoperative bleeding,
which was treated with endoscopic hemostasis. Such
Material and methods: Our research analyzed two
groups of patients. In the first group, patients with low percentages of postoperative complications, even
pathological lesions of the rectum were treated with local in our small series of patients, justify the introduction
transanal excision (TAE), and the second group of patients of the TAMIS procedure into daily practice for
were treated with the newly introduced technique of the surgical treatment of large endoscopically
transanal minimally invasive surgery (TAMIS). In the unresectable rectal polyps of high rectal localization.
period from September 2021 to March 2023. at the CHC Conclusion: Based on our work and the available
Zemun in Surgery Clinic, a total of 12 patients were literature, we can conclude that radical local
operated on with the TAMIS procedure and 15 patients resections of TAE and TAMIS are a viable alternative to
with the TAE technique for various pathological changes surgical radical rectal resection in polypoid changes

ORIGINAL PAPER Galenika Medical Journal, 2024; 3(9):11-18. 11