Levator–sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology

Abstract

The uLAR-LSR method is a novel technical option, which maintains the anorectal function as well as accomplishing oncological safety during a short-term evaluation.

Open versus robot‐assisted sphincter‐saving operations in rectal cancer patients: techniques and comparison of outcomes between groups of 100 matched patients

“…Our mean operation time of 188 min was in the lower ranges of previous studies which reported mean operation times for RA of 190–305 min . Moreover, the mean operation time in our RA group was comparable with previously reported mean times for open (158–247 min) and LA (158–237 min) SSOs . We did find that patients with a shallow pelvis or a high BMI score had an increased console time.…”

“…Postoperative pain was assessed on a visual analog scale (VAS, none = 0 to agonizing = 10) on postoperative day 1, as was the need for extra analgesics in addition to patient‐controlled analgesia (PCA). The operator's physical discomfort (OPD) was evaluated using the Lawson scale immediately after the operation on a VAS (0 = none, 3 = moderate, 5 = severe). Patients were followed‐up every 3–6 months for the first 2 years.…”

“…The rectal anastomosis was performed by double stapling. Otherwise, we routinely combined levator‐sphincter reinforcement by approximation of dissected or resected muscles to the anorectal stump in the open uLAR . The average length of incision was 5 cm for the specimen extraction in RA LAR, whereas it was 21 cm in open LAR.…”

Smooth Muscle Enfoldment Internal Sphincter Construction after Intersphincteric Resection for Rectal Cancer

“…The significant difference between the two groups confirmed that the smooth muscles could be enfolded and thickened to form a structure similar to the internal sphincter. Based on the results of naked eye observation and pathological examination, after surgery, compared to the specimens from the ISR group, the specimens in the SMESC group had thickened muscles in the area enfolded, and the smooth muscle fibers were noted to be thickened, with the morphological characteristics of an internal sphincter [13] , [14] . The results of this study showed that the enfolded bowel smooth muscle that was constructed caused thickening of the internal anal neo-sphincter around the anus and the reconstructed anal high pressure zone, which may work as a passive barrier at rest and improve ano-rectal function in patients with otherwise compromised pelvic floor musculature.…”

Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients

“…At this point, linear stapling was facilitated by raising the anal stump at the perianal area concurrently with operator's pulling of the rectum. Additionally, levator-sphincter reinforcement was achieved by approximating the remnants of the dissected or resected muscles to the anal stump using suture ligation after rectal resection, as previously described [8]. On the other hand, in the uLAR without ISR, the pelvic dissection was stopped before or at the end of the visceral peritoneum lying over the junction of the rectum and levator muscles.…”