Improved Exposure for Excision of Rectal Carcinomas Initial Experiences with a Pubic Resection Technique

Abstract

Preliminary experiences with a transpubic approach for carcinoma of the rectum are described. By excising a wedge of pubic bone and freeing the left lateral attachments of the bladder, the entire length of rectum can be exposed, down to the level of the levator muscles. Dissection of the tumor can be performed under direct vision, even in unfavorable anatomic and pathologic situations. Low rectal anastomoses, at levels of 1--2 cm above the anus, may be performed with greater ease. It is felt that urinary problems should be uncommon and that orthopedic complications should not occur since sacroiliac articulations are not disturbed by retraction.

Symphysiotomy for Pelvic Access in Difficult Extirpative Surgery

“…In Golimbu et al ’s series 287 patients had total or partial (superior or inferior) pubectomy in an attempt to avoid the supposed complications of symphysiotomy with distraction of the pubic bones, however, because most of their complications occurred in the total pubectomy group this procedure was abandoned 2 . There have been sporadic reports in the literature of symphysiotomy being used for increasing exposure in difficult rectal surgery 3 and removal of other pelvic tumours including sarcomas and bladder tumours 4 , 5 . We were introduced to the technique by a visiting surgeon who used the technique for gaining access to the pelvis for difficult recurrent rectal carcinoma with minimal morbidity (W. Temple, pers.…”