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What is Transanal excision?

Transanal excision (TAE) is a minimally invasive surgical procedure to remove benign or early-stage malignant tumors (polyps or small cancers) in the lower rectum through the anus, avoiding major abdominal surgery. It is typically used for lesions within 8–10 cm of the anal verge that are accessible via the anus. In India, transanal excision is performed in specialized colorectal surgery centers, offering affordable, high-quality care. For patients and families in India, understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for informed decision-making and optimal outcomes.

Why do you need Transanal excision?

Transanal excision is indicated for:

  • Benign rectal polyps: Large or villous adenomas not removable via colonoscopy.
  • Early-stage rectal cancer: T1N0M0 tumors (small, superficial, no lymph node involvement), with low risk of metastasis.
  • Palliative cases: For patients unfit for major surgery (e.g., elderly, comorbidities) to relieve symptoms like bleeding or obstruction.
  • Select neuroendocrine tumors: Small, well-differentiated rectal carcinoids.

The procedure aims to remove the lesion with clear margins while preserving rectal function and avoiding a permanent stoma. In India, hospitals like Apollo, Fortis, Tata Memorial, and AIIMS specialize in transanal excision, often using advanced techniques like transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS).

Why Do Transanal Excision Costs Vary in India?

Costs range from ₹50,000 to ₹2.5 lakh:

  • Procedure Type: Standard TAE (₹50,000–₹1 lakh), TEM/TAMIS (₹1–2.5 lakh).
  • Hospital/Location: Higher in metro cities (Apollo, Tata Memorial); lower in government hospitals (AIIMS, ₹20,000–₹80,000).
  • Surgeon’s Expertise: Experienced colorectal surgeons charge more.
  • Additional Costs: Diagnostics (ERUS, MRI), anesthesia, pathology fees.
  • Insurance: Often covered for cancer or symptomatic polyps; Ayushman Bharat offers subsidies.

Transanal Excision Procedure

The procedure is tailored to the lesion’s size, location, and pathology:

  1. Before Surgery Evaluation:
    • Diagnosis:
      • Rectal exam and proctoscopy visualize the lesion.
      • Endorectal ultrasound (ERUS) or MRI assesses tumor depth (T stage) and lymph node involvement.
      • Biopsy confirms pathology (adenoma, T1 cancer, or carcinoid).
      • CT/PET scans rule out metastasis for cancer cases.
    • Blood tests ensure surgical fitness; patients on blood thinners may need to stop them 5–7 days prior.
    • Bowel preparation (enema) clears the rectum on the day of surgery.
    • Patients are counseled on risks, including recurrence and the potential need for further surgery.
  2. Surgical Techniques:
    • Standard Transanal Excision (TAE):
      • Performed under general or spinal anesthesia, lasting 30–60 minutes.
      • The patient is positioned in the lithotomy position (legs raised).
      • An anoscope or retractor exposes the lesion in the rectum.
      • The tumor is excised with a 1 cm margin of healthy tissue using surgical instruments, ensuring full-thickness removal down to the perirectal fat for cancers.
      • The defect in the rectal wall is closed with sutures, though small defects may be left open to heal naturally.
    • Transanal Endoscopic Microsurgery (TEM):
      • A specialized technique using a rigid proctoscope with a stereoscopic camera and instruments.
      • Provides better visualization and precision for lesions 6–10 cm from the anal verge.
      • Takes 1–2 hours; suitable for larger or more proximal lesions.
    • Transanal Minimally Invasive Surgery (TAMIS):
      • A newer approach using a flexible transanal platform (e.g., GelPOINT Path) and laparoscopic instruments.
      • Offers similar precision to TEM but with more flexibility and lower equipment costs.
      • Takes 1–2 hours; increasingly available in centers like Apollo or Medanta.
    • The procedure is outpatient or requires a 1–2 day hospital stay.
  3. After Surgery:
    • Patients are monitored for a few hours for pain control and to ensure no immediate complications.
    • Pathology reports confirm clear margins and tumor stage, guiding further management (e.g., surveillance or additional surgery for cancer).
    • Follow-up visits assess healing and recurrence.

Recovery After Transanal Excision

  1. Hospital Stay: Outpatient or 1–2 days.
  2. Post-Surgery Care:
    • Mild pain for 3–5 days, managed with painkillers (e.g., paracetamol) and sitz baths.
    • Antibiotics are prescribed if infection risk is high.
    • Stool softeners (e.g., lactulose) prevent straining.
  3. Activity/Diet:
    • Light activities resume in 1–2 days; strenuous activities avoided for 2–3 weeks.
    • High-fiber diet (fruits, vegetables, whole grains) and 2–3 liters water daily promote soft stools.
    • Avoid spicy foods for 3–5 days to reduce irritation.
  4. Follow-Up:
    • Visits at 1–2 weeks, 4–6 weeks; cancer patients need proctoscopy/ERUS every 3–6 months for 2–3 years, then annually.
    • Healing completes in 2–4 weeks.

Most resume normal activities in 1–2 weeks. Success rates are 90–95% for benign lesions; local recurrence for T1 cancers is 5–15%, often requiring further surgery.

Risks and Complications

  • Surgical Risks: Bleeding (1–3%), infection, rectal perforation (rare, may require repair).
  • Functional Issues: Temporary incontinence (2–5%, resolves in weeks), rectal stenosis (rare).
  • Cancer-Specific Risks: Local recurrence (5–15% for T1 cancers), missed lymph node involvement (up to 10%), necessitating radical surgery (e.g., low anterior resection).
  • General Risks: Anesthesia reactions.

Report fever, severe pain, or rectal bleeding promptly.

Frequently Asked Questions (FAQs)

What causes the need for transanal excision?

Large rectal polyps, early-stage rectal cancer (T1), or small carcinoids.

Is it a major surgery?

No, it’s minimally invasive, avoiding abdominal incisions.

Can it treat all rectal cancers?

Only early-stage (T1) with low-risk features; advanced cancers need more extensive surgery.

How soon can I resume activities?

Light activities in 1–2 days, normal routines in 1–2 weeks.

Is it covered by insurance in India?

Yes, for cancer or symptomatic polyps; confirm with your provider.

Signs of complications?

Fever, severe pain, rectal bleeding, or incontinence.

Can cancer recur after transanal excision?

Yes, 5–15% risk for T1 cancers; regular surveillance is critical.

Lifestyle changes post-surgery?

High-fiber diet, hydration, avoid straining, regular follow-ups for cancer.

Conclusion

Transanal excision is an effective, sphincter-preserving procedure for benign rectal lesions and select early-stage cancers, with minimal recovery time. India’s top hospitals (Apollo, Tata Memorial, AIIMS) offer affordable, high-quality care. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach transanal excision confidently. Consult a colorectal surgeon for personalized guidance and successful treatment.

Looking for Best Hospitals for Transanal excision

Note: we are not promoting any hospitals

we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)

  • click on your city and schedule your surgery now done in good hands.
City Minimum Price (₹) Maximum Price (₹)
Agra
1,50,000
3,50,000
Ahmedabad
2,00,000
4,00,000
Ajmer
1,50,000
3,50,000
Aligarh
1,50,000
3,50,000
Allahabad
1,50,000
3,50,000
Amritsar
1,75,000
3,75,000
Aurangabad
1,75,000
3,75,000
Bangalore
2,00,000
4,00,000
Bareilly
1,50,000
3,50,000
Belgaum
1,75,000
3,75,000
Bhopal
1,75,000
3,75,000
Bhubaneswar
1,75,000
3,75,000
Bikaner
1,50,000
3,50,000
Chandigarh
2,00,000
4,00,000
Chennai
2,00,000
4,00,000
Coimbatore
2,00,000
4,00,000
Dehradun
1,75,000
3,75,000
Delhi
2,00,000
4,00,000
Dhanbad
1,50,000
3,50,000
Durgapur
1,50,000
3,50,000
Faridabad
2,00,000
4,00,000
Ghaziabad
2,00,000
4,00,000
Gorakhpur
1,50,000
3,50,000
Guntur
1,75,000
3,75,000
Gurgaon
2,00,000
4,00,000
Guwahati
1,75,000
3,75,000
Gwalior
1,50,000
3,50,000
Hyderabad
2,00,000
4,00,000
Indore
1,75,000
3,75,000
Jabalpur
1,50,000
3,50,000
Jaipur
2,00,000
4,00,000
Jalandhar
1,75,000
3,75,000
Jamshedpur
1,75,000
3,75,000
Jodhpur
1,50,000
3,50,000
Kanpur
1,50,000
3,50,000
Kochi
2,00,000
4,00,000
Kolkata
2,00,000
4,00,000
Kollam
1,75,000
3,75,000
Lucknow
1,75,000
3,75,000
Ludhiana
2,00,000
4,00,000
Madurai
1,75,000
3,75,000
Mangalore
1,75,000
3,75,000
Meerut
1,50,000
3,50,000
Moradabad
1,50,000
3,50,000
Mumbai
2,00,000
4,00,000
Mysore
2,00,000
4,00,000
Nagpur
1,75,000
3,75,000
Nashik
1,75,000
3,75,000
Navi Mumbai
2,00,000
4,00,000
Noida
2,00,000
4,00,000
Patna
1,50,000
3,50,000
Pune
2,00,000
4,00,000
Raipur
1,75,000
3,75,000
Rajkot
1,75,000
3,75,000
Ranchi
1,50,000
3,50,000
Surat
2,00,000
4,00,000
Thane
2,00,000
4,00,000
Vadodara
1,75,000
3,75,000
Varanasi
1,50,000
3,50,000
Visakhapatnam
1,75,000
3,75,000

Disclaimer

This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.

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