Laparoscope-assisted anal sphincter-preserving operation preceded by transanal procedure.
BACKGROUND
Transanal intersphincteric resection (ISR) was introduced and has been increasingly performed as an ultimate surgical treatment for extremely low rectal cancer. We considered that high quality and less invasive surgery could be achieved if ISR and laparoscopic surgery were combined.


METHODS
Between December 2003 and June 2004, we performed laparoscope-assisted ISR for two patients with very low rectal cancer and total colectomy for two patients with ulcerative colitis complicated by colorectal cancer. In all patients, the transanal procedure was preceded by trans-abdominal laparoscopic rectal excision.


RESULTS
Preceding transanal dissection facilitated muscle layer-oriented curative dissection, and more importantly, made subsequent laparoscopic rectal excision effortless as a result of penetrating to the dissected pelvic cavity. All patients showed favorable recovery including postoperative anal function with no complication or recurrent disease.


CONCLUSIONS
This procedure is feasible and has favorable short-term results for radical treatment of very low rectal disease, while preserving anal function.
Uchikoshi
F
F
Department of Surgery, Osaka Police Hospital, 10-31 Kitayamacho Tennoji-ku, Osaka University, Graduate Schol of Medicine, 543-0035, Japan. fumihiro@ff.iij4u.or.jp
Nishida
T
T
Ueshima
S
S
Nakahara
M
M
Matsuda
H
H
D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011351:Proctoscopy; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome