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Stepwise approach for intersphincteric dissection in colo-anal anastomosis

J Leroy, MD, FRCS J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Epublication WebSurg.com, Feb 2009;09(02). URL: http://websurg.com/doi/vd01en2465

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  • 2009-02-12
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The surgical technique of intersphincteric resection (ISR) with colo-anal anastomosis has been proposed to offer sphincter preservation and to avoid permanent colostomy in patients with very low rectal carcinoma. Several studies have reported that functional results and local recurrence rates after ISR are satisfactory. The goal of intersphincteric resection is to perform a dissection between the internal sphincter and the external sphincter by beginning the dissection either at the pectinate line or underneath the pectinate line to obtain adequate distal margins as in this case. The trans-anal approach appears to be the optimal way because the dissection is more anatomic and visual and permits a more accurate evaluation of the lower edge of the tumor. In addition, this enables to obtain optimal distal and lateral margins respecting oncological principles and restore bowel continuity in a difficult narrow pelvis and in obese patients. The objective of this video is to show the correct intersphincteric dissection technique used to perform colo-anal anastomosis after complete total mesorectal excision.