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

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  • Skin incision and exposure

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    Skin incision and exposure
     

    Longitudinal laparotomy.

  • Freeing the left colon

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    Freeing the left colon
     

    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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    Managing the inferior mesenteric vein
     

    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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    Managing the inferior mesenteric artery
     

    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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    Entering the lesser pelvis
     

    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.

  • Mesorectal dissection

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    Mesorectal dissection
     
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  • Anterior rectal dissection

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  • Rectal palpation

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    Rectal palpation
     
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  • Exposing the puborectalis muscle

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    Exposing the puborectalis muscle
     
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  • Mounting the Lone Star Retractor System™

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  • Submucosal injection for hemostasis

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  • Intersphincteric excision

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  • Delivering the resectate

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  • Pouch construction

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  • Preplacing the interrupted sutures for the anastomosis

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  • Pulling the oral stump through the lesser pelvis

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  • Completing and tying the interrupted sutures

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  • Removing the anal retractor

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  1. Skin incision and exposure
  2. Freeing the left colon
  3. Managing the inferior mesenteric vein
  4. Managing the inferior mesenteric artery
  5. Entering the lesser pelvis
  6. Mesorectal dissection
  7. Anterior rectal dissection
  8. Rectal palpation
  9. Exposing the puborectalis muscle
  10. Mounting the Lone Star Retractor System™
  11. Submucosal injection for hemostasis
  12. Intersphincteric excision
  13. Delivering the resectate
  14. Pouch construction
  15. Preplacing the interrupted sutures for the anastomosis
  16. Pulling the oral stump through the lesser pelvis
  17. Completing and tying the interrupted sutures
  18. Removing the anal retractor
date of update: 03.09.2023
date of publication: 28.09.2009

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