Improved exposure for excision of rectal carcinomas: initial experiences with a pubic resection technique

Preliminary experiences with a transpubic approach for carcinoma of the rectum are described. By excising a wedge of pubic bone and freeing the left lateral attachments of the bladder, the entire length of rectum can be exposed, down to the level of the levator muscles. Dissection of the tumor can be performed under direct vision, even in unfavorable anatomic and pathologic situations. Low rectal anastomoses, at levels of 1--2 cm above the anus, may be performed with greater ease. It is felt that urinary problems should be uncommon and that orthopedic complications should not occur since sacroiliac articulations are not disturbed by retraction.