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Rectal Eversion Technique

A Method to Achieve Very Low Rectal Transection and Anastomosis With Particular Value in Laparoscopic Cases

Poylin, Vitaliy, M.D.; Mowschenson, Peter, M.D.; Nagle, Deborah, M.D.; Cataldo, Thomas, M.D.

doi: 10.1097/DCR.0000000000000932
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INTRODUCTION: Transection of the rectum at the anorectal junction is required for proper resection in ulcerative colitis and restorative proctocolectomy. Achieving stapled transection at the pelvic floor is often challenging, particularly during laparoscopic proctectomy. Transanal mucosectomy and handsewn anastomosis are frequently used to achieve adequate resection. Rectal eversion provides an alternative for low anorectal transection and maintains the ability to perform stapled anastomosis.

TECHNIQUE: The purpose of this article is to describe a technique for low anorectal transection. The work was conducted at tertiary care center by 2 colon and rectal surgeons on patients undergoing total proctocolectomy with creation of ileal pouch rectal anastomosis for ulcerative colitis. We measured the ability to achieve low stapled anastomosis.

RESULTS: Very low transection was achieved, allowing for creation of IPAA without leaving significant rectal cuff. This study was limited because it is an early experience that was not performed in the setting of a scientific investigation. No sphincter or bowel functional data were obtained or evaluated.

CONCLUSIONS: Rectal eversion technique provides an alternative to mucosectomy when low pelvic transection is difficult to achieve. See Video at http://links.lww.com/DCR/A441.

Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Financial Disclosure: None reported.

Correspondence: Vitaliy Poylin, M.D., Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gryzmish 6, Boston, MA 02215. E-mail: vpoylin@bidmc.harvard.edu

© 2017 The American Society of Colon and Rectal Surgeons