Mark Davies’ write-up Colorectal Endoscope
Major abdominal surgery is gold standard for the management early stage rectal cancer and larger benign polyps but can necessitate the need for a colostomy. The risk of the disease recurring after such surgery is very low around 1-2%. However, there are significant risks associated with this type of surgery (20-30%). There is also the risk of bowel, bladder and sexual dysfunction. This can consequently have a negative impact on quality of life. So in short, we are potentially over treating such benign polyps and early stage rectal cancers.
Transanal endoscopic surgery was introduced by Professor Buess in Germany in 1980s. It has been introduced in many centres worldwide. It has an established use in the UK and its safety and efficacy have been demonstrated by an ongoing audit.
This is a minimally invasive, endoscopic technique, avoiding any abdominal incisions. The technique works via an operating rectoscope with high definition optics and high precision instruments to remove the lesion. The defect in the rectum can be closed accurately. There is no need for a colostomy.
There are significant cost savings as the inpatient stay is around 1-2 nights. This compares to 5-10 nights after resectional surgery. There is faster return to normal health, reduced complications and improved postoperative bowel function compared to resectional surgery.
The Bowel Cancer Screening Programme has led to an increased number of larger rectal polyps and early stage cancers being detected. It is therefore essential that we in Swansea are able to offer patients this treatment, thus avoiding major surgery or referring patients to other centres in UK.
On behalf of The Colorectal Unit, I would like to thank Morriston Hospital League of Friends for their kind donation.