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Transabdominal resection and extraperitoneal anastomosis in the treatment of carcinoma of the upper rectum and lower sigmoid colon


, : Transabdominal resection and extraperitoneal anastomosis in the treatment of carcinoma of the upper rectum and lower sigmoid colon. Zhonghua Waike Zazhi 13(3): 212-214

This report deals with the treatment of 53 cases of carcinoma of the upper rectum and lower sigmoid colon by transabdominal excision and extraperitoneal anastomosis, with special emphasis on the prevention of breaking down of the anastomosis. There was no operative mortality in this series. Breaking down of the anastomosis occurred in 4 cases (7.5%) and was the only complication in this series. In 2 of the cases it was due to inadequate preparation of the bowel, and in the other 2, it was related to the fact that the anastomosis was done under too much tension. In all these 4 cases, supplementary colostomy was not done at the time of operation. Breaking down of the anastomosis usually occurs 4 to 8 days after the operation, and healing frequently takes place shortly after the establishment of drainage. Should the leakage be of considerable size and accompanied by systemic reaction to the infection, colostomy should be done. This was carried out in 3 out of 4 cases in this series, and none of them developed any severe infection. In order to prevent recurrence at the site of anastomosis, the authors usually doubly ligated the bowel proximal to the tumor-bearing area with heavy silk. A right angle clamp was applied at the level of the bowel distal to the tumor where an incision was intended to be made. The anal canal and the lumen of that portion of the rectum to be preserved were thoroughly irrigated with 1:500 mercuric chloride or freshly prepared Dakin's solution. The proximal stump of the colon was similarly treated just before the performance of the anastomosis. No local recurrence was discovered in the radical resections in this series.

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