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

Pathologic lesions in the rectum up to 5cm proximal to the anocutaneous line or which, would not allow the required clearance from the proximal resection line in suprasphincteric anastomosis during low anterior resection; borderline condition between low anterior and abdominoperineal resection.

Tumors invading the sphincter muscles, puborectalis muscle or levator ani muscle. Fecal incontinence irrespective of the tumor.

Relative contraindications:

• Impaired fecal continence

• Endoscopy with biopsy (confirmation of malignancy, complete colonoscopy to confirm/rule out other suspicious findings)
• Possibly air-contrast colon study if complete colonoscopy is not possible
• Ultrasonography/CT (ruling out distant metastases)
• Endorectal ultrasonography, possibly pelvic MRI (local tumor staging)
• Assessment of preoperative and estimation of postoperative sphincteric function
• Possibly urologic and gynecologic diagnostics regarding tumor invasion into neighboring organs

• Orthograde Lavage (intestinal cleansing)
• Prophylactic perioperative antibiotic protocol
• Bladder catheter
• Gastric tube
• Neoadjuvant radio-/chemotherapy, if necessary
• For postoperative follow-up: Tumor markers (CA 19.9, CEA)

• Need for defunctioning loop ileostomy
• Injury to adjacent structures / organs: Bladder, urethra, ureter, seminal vesicles, prostate, vagina
• Hemorrhage requiring allogeneic blood/transfusions
• Anastomotic failure
• Anastomotic stricture
• Fecal incontinence
• Fecal urge incontinence
• Fractionated bowel movement
• Revision surgery