Complications - open intersphincteric rectal resection, with transanal colon pull-through and pouch formation

Transection of the left ureter

• This can be avoided by dissecting in layers and carefully ensuring that only the mesosigmoid is mobilized laterally.
• Furthermore, the ureter should be identified, but to spare the nerve plexuses running in this region, no extensive exposure should be performed. Also, slinging is not common in our own procedure.
• Insertion of a ureteral stent, closure over it with single button sutures, bladder catheter or suprapubic urinary diversion for 10 days.

Bladder injury

• Suture, bladder catheter or suprapubic urinary diversion for 10 days.

Bleeding from the sacral plexus

• This very serious complication, which can quickly become life-threatening, is avoided by preparing very precisely in the mesorectal fascial plane.
• If bleeding does occur, it is usually not possible to control it by ligation (exception: bleeding after injuries to the internal or external iliac vein). Here it is more sensible to perform tamponade early for several minutes, as long as blood clotting is still stable. Smaller bleedings can be reliably controlled by prolonged compression alone.

Anastomotic Insufficiency

• Common complication that can be minimized by a tension-free and excellently perfused anastomosis; special attention on the 6th-9th post-OP day.
• Since a stoma is placed upstream, and the infection in a well-prepared bowel is limited to the pelvis, healing can be achieved through local irrigation and drainage measures including endoluminal vacuum therapy. As a rule, the stoma must be left in place during this period.

Nerve Damage

• Damage to the sympathetic nerve plexuses preaortally results in retrograde ejaculation.
• Nerve damage after the union of sympathetic and parasympathetic fibers at the level of the seminal vesicles leads to erectile dysfunction, impotence, and bladder emptying disorders.

Bladder Emptying Disorder

• Bladder catheter for 5-7 days, microbiological urine examination, if necessary alpha-adrenoceptor antagonists

 Anastomotic Stricture

• postoperatively regular digital control and if necessary dilatation

Fecal Incontinence

• Especially functional deficits such as fecal smearing, gas incontinence, incomplete emptying, increased stool frequency, stool fragmentation, urgency symptoms
  • Regulate stool consistency 
  • Pelvic floor exercises 
  • Bio-feedback therapy
  • The reduced neorectal compliance usually improves after 1 to 2 years.
  • In case of therapy resistance and corresponding suffering of the patient or complications (e.g. sacral decubitus) if necessary conversion to a terminal colostomy.