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Surgical Aspects of Rectal Reconstruction: Alternatives for Ultralow Anastomosis

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Reconstructive Surgery of the Rectum, Anus and Perineum

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Abstract

Various surgical alternatives are routinely used for neorectal reconstruction, although the medium- and long-term data concerning functional benefit is debatable. Poor functional outcomes and the incidence of low anterior resection syndrome are likely more common than reported. The causes of these problems are complex and include anastomotic dehiscence, perianastomotic sepsis, poor pouch volumes, sphincter damage during reconstruction, and the effects of radiation on the sphincter mechanism. The increasing trend toward sphincter preservation has made the assessment and reconstruction of complicated cases more important in clinical practice and has highlighted a greater emphasis on more objective assessments of postoperative quality of life parameters. This chapter outlines the data pertaining to functional outcome after low restorative proctectomy, compares the different methods of rectal reconstruction, and addresses the management approach in difficult cases.

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Acknowledgment

Figures for this chapter were drawn by Rebecca. J. Kwaan, M.D.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota Medical School, Mayo Mail Code 450, 420 Delaware Street SE, Minneapolis, MN, 55455, USA

    Mary R. Kwaan M.D. & Robert D. Madoff M.D.

Authors
  1. Mary R. Kwaan M.D.
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  2. Robert D. Madoff M.D.
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Correspondence to Mary R. Kwaan M.D. .

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Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

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Kwaan, M.R., Madoff, R.D. (2013). Surgical Aspects of Rectal Reconstruction: Alternatives for Ultralow Anastomosis. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_8

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  • DOI: https://doi.org/10.1007/978-1-84882-413-3_8

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