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cijelog zida preparata. U TAE grupi imali smo samo jednog posmatranoj grupi. U jednom slučaju smo imali postopera-
pacijenta sa neslaganjem preoperativnog i postoperativnog tivno krvarenje koje je zbrinuto endoskopskom hemosta-
HP nalaza, što je svega 6,66%, tj. signifikantno niže nego u zom. Ovako mala učestalost postoperativnih komplikacija,
TAMIS grupi. Na ovaj način se i TAE i TAMIS-om postiže ade- čak i u ovoj našoj maloj seriji pacijenata, opravdava uvo-
kvatan „stejdžing“ pacijenata sa polipoidnim i ranim mali- đenje TAMIS procedure u svakodnevnu praksu za hirurško
gnim lezijama rektuma. rješavanje velikih endoskopski neresektabilnih rektalnih
polipa visoke rektalne lokalizacije, u skladu sa drugim stu-
Postoperativni period hospitalizacije je kraći u TAE dijama 27, 28 . Istovremeno mali procenat recidiva i maligne
u odnosu na TAMIS (1,3 dana u odnosu na 1,8 dana). Ni- alteracije poslije resekcije polipa, po literaturnim podacima,
smo imali ozbiljnije postoperativne komplikacije ni u jednoj samo potvrđuje ovu našu tvrdnju .
29

Zaključak

Radikalne lokalne resekcije, TAE i TAMIS, su održiva alternativa hirurškoj radikalnoj resekciji rektuma
kod polipoidnih promjena i ranih T1 karcinoma rektuma. Prednosti ovih tehnika ogledaju se u bržem
oporavku pacijenata, kraćoj hospitalizaciji, manjem broju komplikacija. Ove tehnike su se pokazale

kao sigurne, efikasne i ponovljive. TAE treba primjenjivati na promjene distalnog rektuma, a TAMIS
kod patoloških lezija proksimalne i srednje trećine. Smatramo da će razvojem hirurške tehnike TAE i
TAMIS imati sve veću primjenu u izvođenju složenijih kolorektalnih operacija.

Abstract

Introduction: The most common pathological changes treated in the rectum are neoplastic polyps (villous, tubular, and
tubulovillous adenomas) and rectal adenocarcinomas. Until now, precancerous lesions of the type of neoplastic polyps
have been treated with a local approach, and patients with advanced cancers have been operated on with a radical surgical
intervention, either classically or laparoscopically.

Aim: In this paper, we will show the advantages and disadvantages of certain local surgical approaches to pathological
changes in the rectum.

Material and methods: Our research analyzed two groups of patients. In the first group, patients with pathological lesions
of the rectum were treated with local transanal excision (TAE), and the second group of patients were treated with the newly
introduced technique of transanal minimally invasive surgery (TAMIS). In the period from September 2021 to March 2023.
at the CHC Zemun in Surgery Clinic, a total of 12 patients were operated on with the TAMIS procedure and 15 patients with
the TAE technique for various pathological changes in the rectum. In all patients, the changes were localized in the rectum
from 5 to 15 cm from the anocutaneous line in the TAMIS group and from 0 to 6 cm in the TAE group. Pathological changes
could not be resected by endoscopic polypectomy.

Results: The average duration of the operations was longer in the TAMIS group and amounted to 45 minutes, while
the operations lasted an average of 20 minutes in the TAE group. During the surgical procedure, mucosectomy is most
often performed, followed by resection of the full thickness of the rectal wall, and resection of the rectal wall with part
of the mesorectal tissue was performed the least frequently in both analyzed groups. In 3 patients we had preparation
fragmentation, and in 1 case we had positive margins by histopathological postoperative analysis in the TAMIS group. In
the TAE group, we had one patient with preparation fragmentation and a positive margin. Patients with a positive margin in
both the TAE and TAMIS groups belonged to villous adenomas with a high degree of dysplasia. The final HP finding in both
groups most often spoke in favor of tubulovillous adenoma with a low to medium degree of dysplasia. In both groups, we
had 2 cases of early intramucosal carcinoma T1 stage.

Discussion: The postoperative period of hospitalization is shorter in TAE compared to TAMIS (1.3 days compared to 1.8
days). We had no serious postoperative complications in any of the observed groups. In one case, we had postoperative

ORIGINALNI RADOVI Galenika Medical Journal, 2024; 3(9):15-22. 21