Peranal coloanal XXXX following low anterior resection for rectal carcinoma.

@entity1 @entity834 @entity548 @entity5 @entity75 @entity254 @entity530 @entity2259
Since 1978, 41 @entity1 (12 percent of all restorative operations) have undergone peranal coloanal reconstruction following anterior resection (LAR) for @entity5 of the midrectum. Twenty-seven @entity1 (66 percent) were @entity1 and 14 @entity1 (34 percent) were @entity1 (mean, 58.8 years). The mean distance of the @entity5 from the anal verge was 6.7 cm and 50 percent of the primary @entity5 were considered highly mobile. In 29 @entity1 , a hand-sewn @entity254 was performed between the colon and the dentate line. In the 12 most recent @entity1 , the @entity254 was performed using a circular stapling instrument. A diverting colostomy should be employed in all cases and is closed approximately three months later. There has been no operative mortality. Morbidity included anastomotic separation (two @entity1 ), minor anastomotic defects (three @entity1 ), @entity530 (two @entity1 ), and @entity2259 of unknown origin (two @entity1 ). Where fecal diversion was employed, there were no instances of @entity834 . Two @entity1 with @entity548 were returned to the operating room. Thirty-seven of the 41 @entity1 underwent curative resections. Thirty-three percent of the @entity1 had @entity75 . With a median follow-up of 31 months for the curative resections, 73 percent remain free of disease. Sixty-four percent of evaluable @entity1 have either excellent or good anorectal function nine to 12 months after colostomy closure. Of 26 operations performed by one surgeon, 22 @entity1 (85 percent) are currently evaluable. Nineteen (86 percent) of the 22 have normal or near-normal bowel function. Four guidelines for performing a functionally successful operation are presented. Coloanal reconstruction following LAR, were pull-through operations were previously required, is an excellent sphincter-preserving operation. The functional results one year after the operation are gratifying, with the majority of @entity1 leading an active life with normal bowel function.
