Anterior Resection

17. Anterior Resection

Objective

In case of:

•   Rectal cancer more than 6 cm from anal verge

•   Trauma to the rectum

•   Polyps of the rectum

•   To remove the rectum with anastomosis of sigmoid to anal canal.

Position

Supine with Trendelenburg.

Anesthesia

General.

Incision

Lower midline or transverse.

Procedure

1.  The rectum is mobilized after incising the peritoneal reflections on both sides of the rectal tube.

2.  The branches of the inferior mesenteric artery are divided between ligatures and the rectum is mobilized off the presacral space till the desired level is reached.

3.  The lateral ligaments are divided after protecting the ureters.

4.  At the deserved levels of resection the mesorectum is divided between ligatures and the rectum is divided.

5.  The colon is then anastomosed to the rectal stump using a single layer interrupted anastomosis.

6.  A stapled anastomosis is a good alternative. The presacral space is drained and the wound closed in layers.

Instruments

•   Harrington’s retractor (Fig. 9.26)

•   General set, 1

•   Gastrointestinal set, 1

•   Deep set, 1.

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