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Page 10 of 11 Serra-Aracil et al. Mini-invasive Surg 2019;3:37 I http://dx.doi.org/10.20517/2574-1225.2019.36

The etiology of this asymptomatic fever is not known, although it is probably caused by an inflammatory
reaction to the surgical aggression rather than to a self-limited infection or contamination; in all cases, it
was controlled with antipyretics. We do not consider it as postoperative complication.

Severe perianal infection and the need for colostomy
The removal of lesions in the rectum, with fecal contamination of the resection area, entails a high risk
of developing serious and frequent pelvic infections. Infections are very rare (in our study, only seven
(1%) cases were recorded) but they can be serious. When they appear, antibiotic treatment and local
debridement should be applied as quickly as possible to avoid the need for more radical treatments. Two
of these patients required an end colostomy: one an immunosuppressed patient with a lymphoma, and the
other without associated morbidity.

The limitations of this study are those inherent in observational studies performed at a single center. Its
main strength is the unusually large sample size. All the data reported were recorded prospectively over a
period of 15 years; the experience gathered over this time has allowed us to discuss and establish protocols
for responding to the different complications.

In conclusion, clinically relevant complications after TEM are rare occurrences. Nonetheless, a protocol for
their management needs to be established to ensure that their importance is not underestimated, and to
avoid unnecessary or excessively aggressive treatments.

DECLARATIONS
Acknowledgments
We thank the rest of the members of the Coloproctology Unit for applying the study protocol. We thank
Cristina Gomez Vigo for correcting the manuscript and Michael Maudsley for helping with the English.

Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Serra-Aracil X, Mora-López L, Pallisera-Lloveras A, Serra-Pla S
Performed data acquisition and provided administrative, technical, and material support: Garcia-Nalda A,
Gil-Barrionuevo E, Navarro-Soto S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The present study was approved by the Local Institutional Ethics Committee (CEIC: 2016-636), and
complied with the criteria of the Declaration of Helsinki. The STROBE guidelines for observational studies
were followed.

Consent for publication
Not applicable.