RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Robert M.
SR Print(0)
ID 1127272931
T1 ANTERIOR RESECTION, STAPLED
T2 Zollinger's Atlas of Surgical Operations, 10e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179755-9
LK accesssurgery.mhmedical.com/content.aspx?aid=1127272931
RD 2024/04/20
AB The  stapler  offers  certain  advantages  in  the  performance  of  a  low  anterior  resection,  provided  the  surgeon  is  thoroughly  familiar  with  the  technique.  Those  favoring  this  method  of  approximating  the  sigmoid  to  a  short  rectal  stump  emphasize  the  ease  of  the  anastomosis,  especially  in  the  narrow  pelvis  of  the  male.  The  time  required  for  the  operation  may  be  shortened  and  the  indications  for  a  temporary  proximal  diverting  loop  ostomy  decreased.  Use  of  the  stapler  does  not  alter  the  principles  of  adequate  resection  of  tumors  at  approximately  8  cm  or  less  from  the  anus.  This  is  because  anastomoses  lower  than  3  cm  from  the  anus  may  be  associated  with  incontinence  and  because  a  distal  margin  of  2  to  3  cm  below  the  cancer  is  recommended  to  minimize  the  rate  of  local  anastomotic  recurrence.  The  success  of  a  properly  performed  anastomosis  depends  on  an  adequate  blood  supply  to  the  residual  bowel  segments,  which  can  be  brought  together  easily  without  tension.  Cancers  below  the  peritoneal  reflection  in  the  pouch  of  Douglas  should  be  evaluated  with  endorectal  ultrasound  for  their  staging  and  spread.  Preoperative  radiation  therapy  and  chemotherapy  should  be  considered  for  these  lesions.