What is TEMS?

 

Trans-anal endoscopic microsurgery (TEMS) is a specially designed technique, which allows surgery to be performed within the back passage (rectum) via the anus. This procedure may also be called (TAMIS) Trans-anal minimally invasive surgery.

 

 

Indications

 

It can be used to remove small early cancers or larger polyps from the rectum, avoiding major surgery. It may also be done to complete a full thickness excision at the site of a previous malignant polyp removed at colonoscopy.

 

 

Before the Operation

 

The operation is performed with a general anaesthetic. You will be given a bowel preparation the day before your operation to cleanse your bowel.

 

 

The Operation

 

This is a per-anal procedure using specialised micro-surgical instruments. The polyp or early cancer is fully excised and the defect left behind is closed with sutures.

 

 

What are the risks/complications of surgery?

 

Bleeding

Slight bleeding from the site of surgery is likely for a few days. Occasionally if bleeding persists and shows no signs of stopping, it may be necessary to stop the bleeding with another minor procedure.

 

Pelvic inflammation/infection

The raw area in the rectum where the polyp/cancer has been removed can lead to inflammation around the back passage, this may require treatment with a course of antibiotics but rarely causes problems.

 

There may be slight staining of underwear and seepage of mucous for a few days after the operation; this is  is due to the gentle stretching of the anus during the operation.

 

If it is not possible to complete the operation using the TEMS procedure, very occasionally this may require conversion to a laparoscopic procedure. 

 

 

Post-Operatively

  

After the operation you may feel some minor rectal discomfort, but you should not feel any pain unless the polyp removed was very near the anus itself.

 

A little bit of bleeding is not unusual for the first few days after the operation, but this should not be greater than a little spotting, which is probably most noticeable when having your bowels open for the first time.

 

It is important to avoid constipation by drinking adequate oral fluids and taking adequate fibre in your diet. A mild laxative such as macrogol or lactulose maybe needed to prevent straining.

 

Hospital stay is 1-3 days; avoid excessive physical activity for 1-2 weeks.

 

 

After discharge please call our rooms or seek medical attention after hours if you have any of the following concerns;

 

• Increased pain, not relieved with analgesia as prescribed
• Temperature above 38 c
• Difficulty passing urine
• Significant bleeding from the rectum.
• Nausea or vomiting that doesn’t settle
• Any other concerns.

 

 

Follow-up

 

Histology results are available about 3-5 days after the operation. Please call our rooms to check on results.