The place of the posterior surgical approach for lesions of the rectum.
BACKGROUND
Although there are many advantages of a posterior approach to rectal disease, these procedures are not widely accepted because many surgeons fear the postoperative complications.


METHODS
The medical records were reviewed of 57 patients who underwent a posterior approach to the rectum between January 1980 and December 2002.


RESULTS
Twenty-eight men and 29 women with a mean age of 70.5 (range 47-83) years underwent either a posterior transsacral (n = 52) or a transsphincteric (n = 5) procedure. Indications for surgery were benign lesions (n = 33), e.g. villous adenoma, rectal prolapse and endometriosis as well as invasive adenocarcinoma (n = 24). All patients with an invasive adenocarcinoma were classified as ASA grade III or IV. Postoperative morbidity occurred in 12 patients (21%), consisting of temporary incontinence, anastomotic leakage, wound infection, and hemorrhage. There was no mortality. During a mean follow-up of 29 (range 2-86) months, 3 patients with a villous adenoma and 2 patients who were treated for a malignant lesion had a locally recurrent lesion.


CONCLUSIONS
We believe that a posterior approach to the rectum should be considered for various benign and selected malignant diseases, especially in case of elderly patients or patients with a compromised general condition, and has to be a part of the surgeon's armamentarium.
Terkivatan
T
T
Department of Surgery, Ikazia Hospital Rotterdam, Rotterdam, The Netherlands. turkanterkivatan@hotmail.com
den Hoed
P T
PT
Lange
J F M
JF
Koot
V C M
VC
van Goch
J J
JJ
Veen
H F
HF
D018253:Adenoma, Villous / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011391:Prolapse; D012002:Rectal Diseases / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*