Morbidity after Ultra Low Anterior Resection of the Rectum
N.D. Straja, S. Ionescu, E. Bratucu, M. Alecu, L. SimionGeneral reports, no. 3, 2015
Anterior resections of the rectum, used as an alternative toamputation of the rectum, are performed more and morefrequently, being presently indicated for neoplasms located ata distance of 7 to 4 cm from the anus. Complications of lowand ultra low anterior resections are not at all negligible, and local neoplastic recurrence rate is significantly higher thanafter amputation of the rectum. However, literature data recommends low and ultra low anterior rectal resections, even if sometimes the method indications are pushed to the limit orthe interventions are performed at the patient's request, inorder to avoid permanent colostomy. The authors of this article aim to outline a true picture of the changes caused by anterior resections of the rectum, low and ultra low, so that, without denying the merits of these resections, the entire postoperative pathology that occurs in these patients is depictedand understood. Ultra low rectal resections, up to 3-4 cm fromthe anus, bring important morphological and functionalchanges to the act of defecation and to anal continence. These changes in colo-anal bowel movement have a much higher incidence than postoperative genitourinary disorders. Another important aspect emerging from the present study isrelated to the increased incidence of anastomotic disunity, stenosis and various degrees of incontinence, complications that often can only be solved by completion of rectum amputationand permanent colostomy. In addition, the functionaloutcomes of these ultra low resections are not always at thelevel expected by the patient. Also, in terms of surgical performance, the higher share of specific complications of the procedure raises questions with regard to the technique. For allthese reasons the authors consider it necessary to review thelower limit to which an anterior rectal resection candescend.
