[Serial modifications of bacon's pull through resection for low rectal cancer]

Four modifications of Bacon's pull-thru resection were undertaken to improve postoperative defecatory control and to avoid the 2nd stage resection of the pull-thru colon stump. 54 cases of modified Bacon's rectal resection (9.64% of sphincter saving resections) were performed between 1954-1989. The 1st modification (1954) preserves the levator ani and the intact anorectal ring. The 2nd modification (1964) preserves the dentate margin and anal transitional zone (acute anal sensation), thus greatly improving defecatory control. The 3rd modification (1980) simplified intraanal resective procedure. The 4th modification (1991) was to encircle and ligate the distal end of colon over a sterilized corrugated intraluminal splinting tube (The other end of which is already connected to a long latex tube prior to operation). The latex tube was pulled out thru anus, until the colonic ligature reaches the Dentate margin, to substitute for colonic pull-thru and to divert feces during & after operation, 4-8 fine stitches approximate the colon wall 1 cm proximal to the ligature, to the cut edge of anal mucosa. The colon wall distal to the ligature sloughed in 7-10 days, the proximal colon has partially healed to the raw areas of anal canal without infection. The 2nd stage colon stump resection is thus obviated and hospitalization shortened. The postoperative anal function was good in 86.66%. Modified Bacon's operation is indicated for very low rectal cancer when the rectal remnant above levator ani after adequate resection is less than 1 cm which is difficult for intraabdominal anastomosis. It extends the scope of sphincter-saving operation. It is a good substitute for Park's coloanal anastomosis.