A Case of Rectal Gist Performed Sphincter Saving Operation by Cluneal Arched Skin Incision

Jiro Nagata, Sho Hirabayashi, Eiji Ohnishi, Ken-ichi Nakanishi, Hisaharu Ohya, Ryohei Fukumoto, Tetsuo Nishi, Yuki Morioka, Takahiro Mase and Syoji Hashimoto

Department of Surgery, Ichinomiya Municipal Hospital

We report a new approach in surgery on a 76 year-old man having a submucosal tumor-reaching from the lower rectum to anal canal and suspected of being a gastrointestinal stromal tumor (GIST). Using a cluneal arched incision to form a skin flap with the patient in a jack knife position, we approached the rectum and resected the rectal posterior wall, including the 6.5×4.8×4.0 cm tumor, which proved histopathologically to be uncommitted GIST originating in the rectum. Six weeks later, we closed the diverting colostomy. His sphincter function was well retained. No recurrence was seen in a two-year follow-up. This new approach provides an advantageous operative field with a clear view of the resection safety margin. The posterior approach is superior in rectal GIST compared to previous techniques because it reduces postoperative complications, including wound infection. We discuss our case based on a review of the literature.

Key words
rectal GIST, cluneal arched skin incision, sphincter-saving operation

Reprint requests
Jiro Nagata Department of Surgery, Ichinomiya Municipal Hospital
2-2-22 Bunkyo, Ichinomiya, 491-8558 JAPAN

Accepted
May 27, 2009

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