Information regarding your Transanal TME operation
Your consultant has recommended that you have an operation to remove part of the bowel called the rectum, which is located low down in your pelvis. This operation is sometimes referred to as a TME, or total mesorectal excision. Traditionally, this operation has been done through a cut in the tummy wall, or abdomen. More recently, techniques such as keyhole surgery (inserting surgical tools through small cuts in the abdomen) have been developed which may allow faster recovery with smaller scars. Both open and keyhole surgery require you to have a general anaesthetic.
Both these methods can be tricky when operating low down in the pelvis, as the view the surgeon has can be limited. Your surgeon has suggested a new approach to removing the rectum. This is called a transanal approach. In this technique, special surgical tools are introduced through the anus (back passage), whilst you are asleep. These tools are used to free the rectum up from its surroundings so that it can be removed. The advantage of this technique is that the surgeon has a much better view during this procedure than the view given by traditional or keyhole TME surgery alone. Transanal surgery is, however, usually carried out in combination with traditional or keyhole surgery, as this is necessary to free the bowel higher up. This allows the rectum to be removed, and then if possible, the bowel re-joined at the end of the operation.
It is thought that the better views given by the transanal approach may help make the surgery easier and safer. Specifically, the rectum sits near to some important nerves, which help control our bladder and sexual function. It is possible that these nerves can get damaged in TME surgery. Whilst the surgeon is always careful in trying not to damage these nerves, it is a recognised complication of TME surgery which is mentioned to patients in the process of informed consent. This may be partly due to the limited view given by traditional and keyhole TME surgery through the abdomen. It is thought that the transanal approach may help better protect these nerves from damage during TME surgery, due to the clearer views obtained.
Your surgeon will explain the specifics of the operation to you personally, as these will depend on the individual details of your condition. The operation may involve making a stoma, where part of the bowel is brought out through the abdominal wall (tummy) to empty into a bag. Your surgeon will talk to you about this in some detail if necessary, often with a specialist nurse.