Laparoscopic-assisted abdominoperineal resection with pull-through (sphincter saving)

The sphincter-saving pull-through operation for midrectal cancer has never been popularized because it has been considered to be against the principles of sound cancer surgery, because of its technical difficulty, and because of the assumption that sphincter mass is involved even in the early stages of cancer. We have observed, however, that even in far advanced midrectal cancer sphincter mass is rarely involved, primarily because of the basic difference in drainage systems (lymphatic and vascular) of the lower rectum and the midrectum. We believe therefore, that the pull-through operation for an early midrectal cancer (6-12 cm) is an acceptable procedure, especially for patients who adamantly refuse colostomy and have no gross findings of involvement of the sphincter mass. This paper presents our technique of laparoscopic assisted abdominoperineal resection with pull-through. The advantages of this technique are as follows: (a) it avoids colostomy and maintains continence of stool; (b) blind dissection is unnecessary and minimal bleeding occurs; (c) postoperative wound pain is lessened and time to recovery shortened; (d) exposure is excellent throughout the procedure.