Proctectomy for low rectal cancer with restoration of sphincter, levator and reservoir in perineal part of intestine

Abstract

AIM: To develop surgery of proctectomy with total mesorectectomy, internal and deep external sphincter resection with bringing down of intestine and formation of sphincter, levator and reservoir in its perineal part. MATERIAL AND METHODS: Nine patients aged 38-74 years with low-ampullar rectal adenocarcinoma placed in 8-25 mm from anus underwent proctectomy with total mesorectectomy, internal and deep external sphincter resection and bringing down. There were 4, 1, 3 and 1 patients with T2N0M0, T2N1M0, T3N0M1 and T4N2M1 stages respectively. Simultaneous atypical liver resection was performed in 2 cases. In perineal part of intestine sphincter, levator and reservoir were created using smooth muscle cuff, fixed sero-muscular flap and transversely sutured submucosa respectively. Morphological features of sphincter, levator and reservoir were experimentally studied using histostereometry in dogs. RESULTS: Recurrence-free follow-up from 3 to 9 years was observed in 5 patients (T2N0-1M0). Faecal continence according to Wexner score scale was 11±1.