Operative technique: Intersphincteric resection

Valadão, Marcus; Cesar, Daniel; Graziosi, Guilherme; Leal, Ricardo Ary

doi:10.1590/s2237-93632012000400012

Cited by 4 publications

(2 citation statements)

References 25 publications

(16 reference statements)

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“…The distal resection line may be at the intersphincteric groove (total ISR), or between the dentate line and the intersphincteric groove (subtotal ISR), or at the dentate line (partial ISR) [ 9 ]. According to Valadão et al [ 10 ], a resection of the proximal half of the internal sphincter should be considered when the incision is made on the dentate line or 1 to 2 mm distal to it. If the resection is initiated above the dentate line, but below the anorectal junction, a proximal third removal of the internal sphincter should be considered.…”

Section: Conjoined Longitudinal Musclementioning

confidence: 99%

Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings

Lee

Kim

2018

Ann Coloproctol

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The anorectum is a region with a very complex structure, and surgery for benign or malignant disease of the anorectum is impossible without accurate anatomical knowledge. The conjoined longitudinal muscle consists of smooth muscle from the longitudinal muscle of the rectum and the striate muscle from the levator ani and helps maintain continence; the rectourethralis muscle is connected directly to the conjoined longitudinal muscle at the top of the external anal sphincter. Preserving the rectourethralis muscle without damage to the carvernous nerve or veins passing through it when the abdominoperineal resection is implemented is important. The mesorectal fascia is a multi-layered membrane that surrounds the mesorectum. Because the autonomic nerves also pass between the mesorectal fascia and the parietal fascia, a sharp pelvic dissection must be made along the anatomic fascial plane. With the development of pelvic structure anatomy, we can understand better how we can remove the tumor and the surrounding metastatic lymph nodes without damaging the neural structure. However, because the anorectal anatomy is not yet fully understood, we hope that additional studies of anatomy will enable anorectal surgery to be performed based on complete anatomical knowledge.

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Section: Conjoined Longitudinal Musclementioning

confidence: 99%

Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings

Lee

Kim

2018

Ann Coloproctol

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“…The procedure concludes with a second abdominal procedure for the placement of closed suction drains and creation of a diverting ileostomy. 42 43 …”

Section: Sphincter Preservationmentioning

confidence: 99%

Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer

Nacion¹,

Park

Yang

et al. 2018

Yonsei Med J

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Despite innovative advancements, the management of distally located rectal cancer (RC) remains a formidable endeavor. The critical location of the tumor predisposes it to a circumferential resection margin that tends to involve the sphincters and surrounding organs, pelvic lymph node metastasis, and anastomotic complications. In this regard, colorectal surgeons should be aware of issues beyond the performance of total mesorectal excision (TME). For decades, abdominoperineal resection had been the standard of care for low-lying RC; however, its association with high rates of tumor recurrence, tumor perforation, and poorer survival has stimulated the development of novel surgical techniques and modifications, such as extralevator abdominoperineal excision. Similarly, difficult dissections and poor visualization, especially in obese patients with low-lying tumors, have led to the development of transanal TME or the “bottom-to-up” approach. Additionally, while neoadjuvant chemoradiotherapy has allowed for the execution of more sphincter-saving procedures without oncologic compromise, functional outcomes remain an issue. Nevertheless, neoadjuvant treatment can lead to significant tumor regression and complete pathological response, permitting the utilization of organ-preserving strategies. At present, an East and West dualism pervades the management of lateral lymph node metastasis, thereby calling for a more global and united approach. Moreover, with the increasing importance of quality of life, a tailored, individualized treatment approach is of utmost importance when taking into account oncologic and anticipated functional outcomes.

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Major Resections in Rectal Cancer

Vîlcea

Mirea

2020

Multidisciplinary Treatment of Colorectal Cancer

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Operative technique: Intersphincteric resection

Cited by 4 publications

References 25 publications

Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings

Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings

Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer

Major Resections in Rectal Cancer

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