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Serra-Aracil et al. Mini-invasive Surg 2019;3:37 I http://dx.doi.org/10.20517/2574-1225.2019.36 Page 7 of 11

Figure 2. Chest X-ray with massive pneumoperitoneum

Table 4. Description of surgical complications related to TEM
Total number of patients with complications related to TEM 158/716 (22.1%)
Patients with surgical complications 139 (19.4%)
Patients with medical complications 13 (1.8%)
Patients with both medical and surgical complications 6 (0.8%)
Rectal bleeding Overall morbidity 115/716 (16.1%)
Morbidity (Cl-D) I 85/115 (73.9%)
II 5/115 (4.3%)
IIIa 10/115 (8.7%)
IIIb 11/115 (9.6%)
IVa 4/115 (3.5%)
IVb 0/115 (0%)
V (mortality) 0/115(0%)
Clinically relevant morbidity (Cl-D > II) 25/716 (3.5%)
Urinary complications 30/716 (4.2%)
AUR 20/716 (2.8%)
UTI 9/716 (1.3%)
Hematuria and traumatic urine catheter insertion 5/716 (0.7%)
Infectious complications 14/716 (2%)
Abscess 7/716 (1%)
Pneumoperitoneum/retropneumoperitoneum/pneumomediastinum 2/716 (0.3%)
Recto-vaginal fistula 5/716 (0.7%)
TEM: transanal endoscopic microsurgery; AUR: acute urine retention; UTI: urinary tract infection; Cl-D: Clavien-Dindo

complications (Cl-D ≥ II). We believe that the description of postoperative complications should apply the
[7]
same classification to allow comparison of the results. The Clavien-Dindo classification is probably the
most widely used in the literature; the Comprehensive Complication Index (CCI) is useful for completing
[12]
the description of complications in procedures associated with high morbidity, but in TEM it is of little
[6]
value .

As noted above, there are few references to the management of these complications in the literature.
Because of the lack of information, some of these complications may be overtreated; alternatively, others
may be ignored and may evolve into more complex forms. For this reason, the objective of this study was
to assess the most frequent types of complication based on our experience and on the literature.