# Transanal minimally invasive (TAMIS) mucosal resection with muscular plication for patients with obstructed defecation syndrome—A prospective pilot study

## TL;DR

A new minimally invasive surgery called TAMIS mucosectomy with muscular plication was tested for treating obstructed defecation syndrome, showing initial safety and some symptom improvement.

## Contribution

A novel surgical approach combining TAMIS mucosectomy and muscular plication for obstructed defecation syndrome is introduced and evaluated.

## Key findings

- TAMIS mucosectomy with muscular plication was performed safely in 11 patients with obstructed defecation syndrome.
- Four out of five patients with preoperative fecal incontinence reported symptom improvement after surgery.
- No significant changes in quality of life were observed using the SF-12 survey.

## Abstract

Rectocele and intussusception are frequently observed during defecography as potential contributors to obstructed defecation syndrome (ODS). We aimed to describe our initial experience with transanal minimally invasive surgery (TAMIS) mucosectomy with muscular plication, as a novel surgical approach to treat patients with ODS.

Conducted between August 2021 and October 2023 at the Medical University of Vienna, 11 patients (8 female) were prospectively enrolled and underwent TAMIS mucosectomy with circular mucosectomy and longitudinal muscular plication (internal Delorme’s procedure). Functional outcome and quality of life were assessed by using standardized questionnaires pre- and postoperatively. The median follow up time was 16 months.

In defecography rectal intussusception could be observed in all patients and rectocele was found in nine patients (81.8%). The median age at the time of surgical procedure was 56 years (range 28–76 years). Neither intraoperative nor postoperative complications occurred. The median ODS score decreased from 16 to 11 points (p = 0.171), and four out of five patients (80%) with preexistent fecal incontinence reported improvement of their symptoms postoperatively (80%), though one patient had new onset of fecal incontinence symptoms. No significant changes could be demonstrated in terms of quality life by using the Short-Form Health Survey 12 (SF-12) survey.

Our initial results showed that TAMIS mucosectomy is a safe technique, offering a viable alternative transanal approach for treating symptomatic ODS. Future studies with a larger sample size and a longer follow-up period should enhance the robustness of our preliminary findings.