title: The Kraske procedure: a critical analysis of a surgical approach for mid-rectal lesions.
abstract: OBJECTIVE
  To analyze the Kraske procedure as an approach to mid-rectal disease.
  
  
  METHODS
  Twenty-two patients underwent a Kraske procedure at either Duke University Medical Center, the Durham Veterans Administration Medical Center, or the Durham Regional Hospital between 1992 and 1997. The clinical and pathologic characteristics of these patients were retrospectively analyzed and compared with previous published series.
  
  
  RESULTS
  Of the 22 patients, 13 underwent resection of an adenocarcinoma and 9 underwent resection of a villous adenoma. Post-operative complications included four fecal fistulas (two of which required a temporary diverting colostomy), two wound infections, two cases of urinary retention, and one case of transient fecal incontinence.
  
  
  CONCLUSIONS
  The Kraske procedure minimizes exposure of mid-rectal lesions without the morbidity of a major laparotomy. However, it does carry a moderate complication rate and thus should be utilized selectively in managing patients with mid-rectal tumors not amenable to other treatment options.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Onaitis
authors.forename: Kirk
authors.initials: K
authors.lastname: Ludwig
authors.forename: Anthony
authors.initials: A
authors.lastname: Perez-Tamayo
authors.forename: Marcia
authors.initials: M
authors.lastname: Gottfried
authors.forename: Linda
authors.initials: L
authors.lastname: Russell
authors.forename: Phillip
authors.initials: P
authors.lastname: Shadduck
authors.forename: Theodore
authors.initials: T
authors.lastname: Pappas
authors.forename: Hilliard F
authors.initials: HF
authors.lastname: Seigler
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D018253:Adenoma, Villous / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011351:Proctoscopy; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques