[Perineal clamping of the everted rectum in conservative coloproctectomy. Experimental and clinical results].
Technical alternatives in conservative proctocolectomy are presently investigated to improve the safety and the functional results of the operation. Abdominal transection of the rectum is not always satisfactory in this procedure. A new technique of stapled anastomosis is described: after full mobilization and eversion of the rectum, this latter is closed using a linear stapler and cut immediately above the anal canal via a perineal access; a 18 cm long J pouch is constructed and the anastomosis is stapled using the new premier EEA instrument through the staple line of the previously transected anorectal junction. This technique has been evaluated in dogs (N = 10): colo-anal anastomosis was easy, quick, and safe to perform. Clinical, radiological and gross results have confirmed the quality of these circular stapled anastomoses through an inverting linear suture of the anorectal junction. Clinical experience is actually based on 7 patients operated since January 1989 (proctocolitis: 3, polyposis: 4). The value of the technique was confirmed with ileostomy closure at 3 months for the 7 patients and good functional results. This method has several advantages: 1) to retain all of the anal canal, 2) to avoid prolonged anal dilatation, 3) to perform a rapid and safe stapled anastomosis.
Lehur
P A
PA
Service de Chirurgie Générale et Digestive, Hôpital G.R. Laënnec, Nantes.
Cloarec
D
D
Bucas
J P
JP
Leborgne
J
J
D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000295:instrumentation* / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery; D003106:Colon / Q000601:surgery; D003111:Colonic Polyps / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013528:Surgical Staplers; D013536:Suture Techniques
L'agrafage périnéal du rectum éversé dans la coloproctectomie conservatrice. Résultats expérimentaux et cliniques.