Resection of the rectum and total excision of the internal anal sphincter with smooth muscle plasty and colonic pouch for treatment of ultralow rectal carcinoma

• Published in: British journal of surgery 2004-11, Vol.91 (11), p.1506-1512
• Main Authors: Vorobiev, G. I., Odaryuk, T. S., Tsarkov, P. V., Talalakin, A. I., Rybakov, E. G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Artificial Organs; Colonic Pouches; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Muscle, Smooth - transplantation; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Pressure; Rectal Neoplasms - physiopathology; Rectal Neoplasms - surgery; Surgical Flaps; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4330

Background: Intersphincteric resection can provide tumour‐free margins for rectal tumours located 0–1 cm above the dentate line. However, the internal anal sphincter (IAS) is partially or totally resected and some degree of anal incontinence may develop. A novel technique of smooth muscle plasty of the IAS and colonic pouch construction is described, along with an assessment of morbidity, oncological results and functional outcome. Patients and methods: Between 1997 and 2002, 27 patients (16 men; median age 55 (range 26–75) years) were operated on for T2–3 N0–1 M0 rectal carcinoma located a median of 1·0 (range 0·5–1·5) cm from the dentate line. Resection of the IAS was performed transanally. A smooth muscle cuff, fashioned from the muscular layer of colon, and a colonic pouch were used for anorectal reconstruction. Results: There were no perioperative deaths. Anastomotic leakage developed in two patients. After a median follow‐up of 38 (range 14–66) months no local recurrence was detected. Distant metastases occurred in three patients, two of whom died. Perfect functional outcome was achieved in 22 of 26 patients. At 6 months after surgery the mean(s.d.) resting anal pressure was 49(8) mmHg. Conclusion: In selected patients intersphincteric resection does not compromise the oncological result. The suggested anorectal reconstruction may improve the functional outcome. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Novel technique to enhance function and allow ultra low anastomosis