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Determination of the peritoneal reflection using intraoperative proctoscopy.
Melissa M Najarian1, G Eric Belzer, Thomas H Cogbill
1Department of General and Vascular Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin, USA.
Diseases of the Colon and Rectum
|January 20, 2005
Summary
The rectal peritoneal reflection is higher than previously thought, with no gender differences. This finding aids surgeons in optimizing transanal resection techniques for rectal cancer.
Area of Science:
- Colorectal Surgery
- Surgical Anatomy
- Gastrointestinal Oncology
Background:
- Transanal excision is suitable for 3-5% of rectal carcinomas.
- Resection via transanal excision or transanal endoscopic microsurgery requires tumors located below the peritoneal reflection.
- The precise location of the peritoneal reflection in living patients remains understudied.
Purpose of the Study:
- To investigate and map the location of the peritoneal reflection in living patients.
- To provide anatomical data crucial for surgical planning of transanal rectal resections.
- To assess potential gender-based differences in peritoneal reflection height.
Main Methods:
- A prospective study involving 50 patients undergoing laparotomy.
- Simultaneous intraoperative proctoscopy and direct intra-abdominal visualization were used.
- Measurements of the distance from the anal verge to the peritoneal reflection were recorded.
Main Results:
- The mean distances to the peritoneal reflection were 9 cm (anterior), 12.2 cm (lateral), and 14.8 cm (posterior) for females.
- For males, the mean distances were 9.7 cm (anterior), 12.8 cm (lateral), and 15.5 cm (posterior).
- Measurements showed statistically significant differences between anterior, lateral, and posterior locations (P < 0.01), irrespective of gender. No proctoscopy complications occurred.
Conclusions:
- The rectal peritoneal reflection is situated higher in living individuals than suggested by cadaveric studies.
- No significant gender-based variations in the peritoneal reflection's location were observed.
- Accurate knowledge of the peritoneal reflection's position is vital for surgeons to effectively utilize transanal resection methods for rectal cancer.