The Significance of Intraoperative Repositioning for the Patients who Undergoing Rectal Amputation -Comparison Study of Tow Surgical Techniques which are Abdominoperineal and Sacroabdominal Rectal Amputation-

Shun-ichi Ishigami, Kazuhiko Kitaguchi, Morito Sakikubo, Ryou Kamimura, Katsuaki Ura, Hideaki Ooe, Akira Yoshikawa, Jun Tamura, Nobuo Baba and Shirou Sakanashi

Department of Surgery, Otsu Red Cross Hospital

Aim: The mode of rectal amputation, i.e abdominoperineal [Miles], sacroabdominal [SA], abdominosacral and abdominosacroabdominal [ASA], is based on repositioning for the surgical approach. Miles requires no intraoperative repositioning, but hemostasis from the prostatic or vaginal posterior wall is often difficult. We identified the significance of intraoperative repositioning in those undergoing SA rectal amputation. Patients and methods: Subjects were 134 consecutive rectal cancer patients undergoing rectal amputation, which mode was Miles (70 cases) or SA (64 cases), at our institution from April 1998 to March 2007. Operating time, intraoperative blood loss and postoperative hospitalization were recorded and analyzed. Results: Although SA required more time for repositioning, operating time was statistically shorter than that for Miles (315.1±8.6 vs. 365.6±10.5 minutes, p=0.0004). Mean operating time in those cases of which performed lateral pelvic node dissection, was statistically prolonged in enforcement cases (p=0.028). But the dissective rate among these two groups was similar. Intraoperative blood loss of SA was statistically less than that for Miles (790.9±69.4 vs. 1,338.0±164.1 ml, p=0.0035). Conclusions: Intraoperative repositioning for patients undergoing rectal amputation helps reduce blood loss and operating time. We would like to utilize actively intraoperative repositioning for adequate patients undergoing rectal amputation, and to hand over a younger surgeon in the future.

Key words
intraoperative repositioning, rectal amputation, Miles, sacroabdominal, blood loss

Reprint requests
Shun-ichi Ishigami Department of Surgery, Otsu Red Cross Hospital
1-1-35 Nagara, Otsu, 520-8511 JAPAN

Accepted
October 29, 2007

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