What information is included in the informed consent for total mesorectal excision (TME)?

Updated: Feb 16, 2021
  • Author: Nanda Kishore Maroju, MRCS, MS, MBBS, DNB; Chief Editor: Kurt E Roberts, MD  more...
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The advantages of total mesorectal excision (TME) are better clearance of the tumor and hence lower rates of recurrence and better 5-year survival rates. However, in patients who undergo TME as a part of anterior resection, there is a higher rate of anastomotic dehiscence. In practice, this has lowered the threshold for considering a covering ileostomy. It may be a safer option to consider an ileostomy than to risk an anastomotic leak.

Patients should be informed that they may also experience urgency and incontinence to a higher degree than they would if TME were not performed. However, these issues usually decrease with time. The choice of a colonic pouch may reduce the urgency and incontinence in the early postoperative period. An indwelling catheter may be retained for a week for the bladder to regain its tone, especially in men.

The risks of deep venous thrombosis (DVT), pulmonary embolism (PE), intraoperative bleeding, and postoperative bleeding also must be explained.

The process of consenting should ensure that the patient has a chance to speak to a stoma nurse, a colorectal specialist nurse, or both. This is important not only for helping the patient understand the implications of a stoma but also for ensuring that the patient has access to specialist nursing care and support in the postoperative period.

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