The Place of the Posterior Surgical Approach for Lesions of the Rectum

T Terkivatan, Türkan Terkivatan, P T den Hoed, Jessica Lange, J F M Lange, V C M Koot, J J van Goch, H F Veen
Digestive surgery · 2005 · vol. 22(1-2) , pp. 86–90 · doi:10.1159/000085298 · PMID:15849468 · W2037664548
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Abstract

BACKGROUND: Although there are many advantages of a posterior approach to rectal disease, these procedures are not widely accepted because many surgeons fear the postoperative complications. METHODS: The medical records were reviewed of 57 patients who underwent a posterior approach to the rectum between January 1980 and December 2002. RESULTS: Twenty-eight men and 29 women with a mean age of 70.5 (range 47-83) years underwent either a posterior transsacral (n = 52) or a transsphincteric (n = 5) procedure. Indications for surgery were benign lesions (n = 33), e.g. villous adenoma, rectal prolapse and endometriosis as well as invasive adenocarcinoma (n = 24). All patients with an invasive adenocarcinoma were classified as ASA grade III or IV. Postoperative morbidity occurred in 12 patients (21%), consisting of temporary incontinence, anastomotic leakage, wound infection, and hemorrhage. There was no mortality. During a mean follow-up of 29 (range 2-86) months, 3 patients with a villous adenoma and 2 patients who were treated for a malignant lesion had a locally recurrent lesion. CONCLUSION: We believe that a posterior approach to the rectum should be considered for various benign and selected malignant diseases, especially in case of elderly patients or patients with a compromised general condition, and has to be a part of the surgeon's armamentarium.

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Condition tags

endometriosis

MeSH descriptors

Digestive System Surgical Procedures Rectal Neoplasms Adenoma, Villous Adenoma, Villous Aged Aged, 80 and over Endometriosis Endometriosis Female Humans Male Middle Aged Prolapse Rectal Diseases Rectal Diseases Rectal Neoplasms

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