Transsphincteric approach to the rectum

Abstract

During a transsphincteric operation the patient is prone with the legs sliahtly abducted and the hip and knee joints flexed at right angles. The pelvic floor is opened by means of a left parasacral incision and, if necessary, the sphincters are divided providing an excellent exposure of the caudal rectum and anal canal. At the end of the procedure the pelvic floor and the sphincters are repaired anatomically so that normal defecation and continence are preserved. 106 surgical interventions on the rectum were performed by the sphincter splitting parasacral approach from January 1974 to June 1985. Very good results were obtained by this technique when applied to benign tumours, fistulas and traumatic lesions. Radical resection of certain very low malignant tumours restricted to the bowel wall as well as lymph node staging are possible by this technique. In the case of recto-sigmoid prolapse, resection of the protruding bowel segment and tightening of a lax pelvic floor are achieved by the parasacral transsphincteric operation. The transsphincteric approach is also a highly suitable technique in the treatment of high fistulae and traumatic lesions. Severe complications are rare assuming accurate preliminaries and surgical skill.