Results

The technique of TEM was introduced into clinical practice in Cologne, Germany, 1983. In the Czech Republic, the first intervention was performed in Ceske Budejovice in 1992. Kyjov had the first TEM equipment in 1996, and Brno had it in the same year. Recently, in Czechia, there were 13 surgical departments with TEM equipment. Till 2003, 285 patients had been operated on in Ceske Budejovice, 393 in Kyjov and 298 in Brno. So there are 976 patients in these 3 centres (Table 1). The others have smaller

Table 1. TEM 1992-2003

2

Polyps

Ca

Others

C. Budejovice

28S

193

6S

1S

since 1992

Kyjov since 1996

393

209

160

24

Brno since 1996

298

1S8

122

18

I

976

S60

347

S7

Table 2. Polypectomy methods

1992-2003

Surgical methods used

TEM

560

Transanal

60

Parasacral

36

Trans-sphincteric

24

experiences, so we have not included them in our statistics.

In the above-mentioned centres 560 patients were operated on because of benign polyps, 347 because of early cancer and 57 due to other diagnoses. In the same period, other surgical methods were used too (Table 2). Thirty percent of the adenoma group was treated by a mucosectomy, 66% by a full-thickness excision and 3% by segmental resection. The average operating time was 77 min for mucosectomy, 122 min for full-thickness resection and 184 min for segmental resection. The tumour size ranged from 0.8 to 65 cm2. The average was 16 cm2.

Complications occurred in 6.6% of the polyp group. Two patients required colostomy caused by dehiscence of the suture line, 1 developed rectovagi-nal fistula, seven had post-operative bleeding and required transanal haemostasis.

In the carcinoma group, 11% required surgical intervention because of complications. Five underwent Hartmann's procedure and colostomy caused by suture line dehiscence. Thirteen patients underwent low anterior reresection due to carcinoma recurrence. Eight underwent abdominoperineal resection. In only three was radiotherapy applied.

As to other indications, there was inflammatory bowel disease in 19, fistulas in 15, stenoses in 10, endometriosis in 6, foreign body in 3 and bleeding in 4 patients. The conversion rate was 4% (perforation, bleeding and too large tumour).

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