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KMID : 0356720080240060487
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Journal of the Korean Society of Coloproctology
2008 Volume.24 No. 6 p.487 ~ p.491
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Postanal Retrieval and Anastomosis in Laparoscopic Rectal Surgery : Report of 3 Cases
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Shin Il-Yong
Lee Kwan-Ju
Kim Hyung-Rae
Kim Say-June
Kim Jeong-Gu
Kim Hyung Jin
Lee Dong-Ho
Lee Yoon-Suk
Lee In-Kyu
Kang Won-Kyung
An Chang-Hyeok
Oh Seung-Tack
Kim Jun-Ki
Ahn Chang-Joon
Lee Sang-Chul
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Abstract
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Laparoscopic surgery is popular and widely accepted method for colorectal cancer today. Especially in rectal cancer, laparoscopic TME made surgery safe and feasible with good outcome. But there are still some limits and difficulties in resection and anastomosis of low rectal cancer. We combined laparoscopic TME and posterior approach. Surgery was performed in three low rectal cancer patients. They were prepared in supine position and laparoscopic TME to pelvic floor muscles was performed. After changing the patient to Jack-knife position, post-anal median incision (between the external sphincter and coccyx) and distal rectal resection was done. Through this surgical window, proximal stump was retrieved and resected with the safety margin, and anastomosis with leak test was performed. After a drain keeping, patient’s position was changed back to supine again and laparoscopic irrigation and inspection of operation field was done finally. In the course of recovery, two patients were uneventful, but the rest with FAP experienced postoperative anastomotic leakage and got perineal resection and permanent ileostomy. According to our experience, posterior approach after laparoscopic TME permit right angle resection of distal rectum which is difficult in laparoscopic transabdominal approach. In addition, manual anastomosis with various instruments, Lembert suture, easy drain keeping, accurate fibrin glue apply can also be achieved. No incision on abdomen adds cosmetic advantage. But frequent position changes, need of patience-demanding intracorporeal mesenteric dissection to anastomotic site, and wound discomfort during sitting position right after the operation remain as challenges to consider and solve.
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KEYWORD
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Rectal cancer, Laparoscopy, TME, Postanal, Retrieval
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