Intersphincteric resection, open, with transanal colon pull-through and transverse coloplasty pouch

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Skin incision and exposure
Freeing the left colon
Managing the inferior mesenteric vein
Managing the inferior mesenteric artery
Entering the lesser pelvis
Mesorectal dissection
Anterior rectal dissection
Rectal palpation
Exposing the puborectalis muscle
Mounting the Lone Star Retractor System™
Submucosal injection for hemostasis
Intersphincteric excision
Delivering the resectate
Pouch construction
Preplacing the interrupted sutures for the anastomosis
Pulling the oral stump through the lesser pelvis
Completing and tying the interrupted sutures
Removing the anal retractor

Authors

Prof. Dr. med. Markus Heiss

Krankenhaus Merheim

Skin incision and exposure

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Longitudinal laparotomy.
Freeing the left colon

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Free the left colon up to the middle of the transverse colon with release of the splenic flexure. Identify and dissect the inferior mesenteric vein, ligament of Treitz and the arterial blood supply.
Managing the inferior mesenteric vein

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High ligation and suture ligation of the inferior mesenteric vein at the inferior aspect of the pancreas.
Managing the inferior mesenteric artery

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After suture ligation of the inferior mesenteric artery close to its origin, divide the artery while sparing the superior hypogastric plexus.
Entering the lesser pelvis

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After instituting Trendelenburg position, open the peritoneum at the base of the mesosigmoid and mesorectum on both sides from anteriorly to the promontory down to the pouch of Douglas, and then open the "holy plain" posterior to the mesorectum, respecting the layers and the hypogastric nerves.
Perform this dissection akin to total mesenteric excision.