TECHNIQUE FOR LEVATOROSPHINCTEROPLASTY IN ABDOMINOANAL RESECTION OF RECTUM DUE TO CANCER

摘要

A technique for levatorosphincteroplasty in the abdominoanal resection of the rectum due to cancer comprises the mobilization of the rectum with cancer, the preparation for descending the viable sigmoid graft, the mobilization of the anal canal by the perineal access with the dissection of the levators, the exteriorization of the graft to the perineum, the formation of the colonoanal anastomosis. At the perineal step of then surgery, after the resection of the rectum with cancer the rubber cup is put onto the sigmoid graft and the gauze tape is attached. The descended graft is returned to the abdominal cavity. The surgical wound is stretched out with the retractors. The fibers of the dissected muscles (rectococcygeal muscle posteriorly, iliococcygeal muscle on the right and on the left, pubococcygeal muscle on the right and on the left) are then sewed up with two U-shaped sutures. Upon the traction with the aid of the gauze tape, the sigmoid graft is exteriorized onto the perineum and fixed to the perianal skin with the interrupted silk sutures. In such a way, the bed of the anal canal is generated where the graft of the descended colon is sequentially surrounded by the muscular fibers of the restored pelvic diaphragm reconstructed with the aid of the fixation of the fibers of ectococcygeal, iliococcygeal, and pubococcygeal muscles as well as the subcutaneous part of the external anal sphincter.