INTERSPHINCTERIC RECTAL RESECTION WITH CO LOSPHINCTERIC POUCH

In rectal cancer the emphasis has moved towards sphincter saving resec tion. Tumor site and penetration depth decide the operative technique in low rectal cancer. 1) Resection at the upper confinement of the ana l canal. 2) Intersphincteric resection at the level of the dentate lin e. Reconstruction is achieved by a colonic J-pouch. From 1991 to 1994 we operated on 35 patients with an average age of 58.1 years. An inter sphincteric resection was performed in 11 patients whose tumor was sit uated between 0 and 2 cm upwards the dentate line. 24 cancers were sit uated between 2 and 6 cm of the dentate line and were resected at the upper confinement of the anal canal with a linear stapler. Tumor penet ration depth was determined endosonographically (ES). Four patients ha d tumor stage ES T1, 13 ES T2 and 18 ES T3. A J-pouch of 7-9 cm size w as sutured (11) or stapled (24) to the anal canal. In 10 patients who underwent intersphincteric resection the pre- and postoperative anal p ressures were determined. We did not encounter major complications. In three patients a leakage at the coloanal anastomosis postponed closur e of the diverting colostomy. We had no anastomotic recurrence but one pelvic side recurrence. Four patients developed liver metastases; in one case resectable. Postoperative anal sphincter pressure was reduced in all cases but clinically relevant only in one. This patient has fr equent major soiling, three patients have occasional minor leak. Two p atients are incontinent of gas, 26 are perfect continent. One patient has bowel movements every two days, 15 one per day, 12 two per day and 3 three per day. The colon pouch functionates as a motility brake.