[Open surgery of the rectum]

This article describes the individual techniques and strategies of conventional surgery of the rectum, including photographic documentation of the important steps. Our own figures of postoperative complications and long-term oncological results obtained by this approach are added. In our experience, operations for radical surgery of rectal cancer have been the most frequent procedures. In the pelvis, the important planes between which dissection occurs are (1) the mesorectal fascia up to the origin of the inferior mesenteric artery and continuing laterally to the mesosigmoid fascia and (2) on the opposite side the autonomous nerves forming the plexus and web-like layers. Apart from rectal excision, complete mobilisation of the descending colon and the splenic flecture is a prerequisite for tension-free anastomoses and low leakage rates. Again this dissection follows the plane between the mesocolon and the parietal fascia covering the retroperitoneal organs. The greater omentum has to be taken down from the transverse colon with exposure of the entire lesser sac, followed by the division of the transverse mesocolon along the inferior aspect of the pancreas, including central tying of the inferior mesenteric vein.