TY - CHAP M1 - Book, Section TI - Low Anterior Resection A1 - Ellison, E. Christopher A1 - Zollinger, Jr., Robert M. A1 - Pawlik, Timothy M. A1 - Vaccaro, Patrick S. A1 - Bitans, Marita A1 - Baker, Anthony S. PY - 2022 T2 - Zollinger’s Atlas of Surgical Operations, 11e AB - This may be the operation of choice in selected individuals with malignant lesions in the rectosigmoid or low sigmoid area in order to reestablish the continuity of the bowel. The operation is based on the premises (1) that the viability of the lower rectum can be sustained from the middle or inferior hemorrhoidal vessels and (2) that carcinoma in this region as a rule metastasizes cephalad, only rarely metastasizing 3–4 cm below the primary growth. While most patients prefer restored continuity over a permanent colostomy, low colorectal anastomoses carry a significant risk of postoperative bowel dysfunction (post-low-anterior syndrome) that is highest in patients with anastomoses within 3 cm of the anal verge and those with preoperative dysfunction such as incontinence. The absolute indications for abdominoperineal resection are discussed in Chapter 64, but there are many times when the growth can be mobilized much more than anticipated, especially when the bowel is released down to the levator muscles. The exposure is another factor that may influence the surgeon for or against a low anastomosis. A low anastomosis is much easier and safer in females than in males, especially if the pelvic organs of the former have been removed previously. A loop ileostomy (see Chapter 55) is sometimes done at the time to divert the fecal stream temporarily from the end-to-end anastomosis. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1187821859 ER -