Laparoscopic Abdominoperineal Resection of the Rectum

Abstract

The surgical technique of laparoscopic abdominoperineal resection requires laparoscopic resection of the low anterior rectum. However, procedures beyond the rectosacral ligament must maintain sufficient distance from the rectum and/or the anal canal, which is defined as the circumferential resection margin. This surgery is fundamental to ablate the anorectal tube and the surrounding tissue maintaining its cylindrical shape. This surgery should not lead to “waisting” (or “necking” in the resected specimens), which simply means not getting extremely close to the lesion. However, few papers have been published with a detailed description of this anatomy. This is because the concept of fascial composition of this section is directly connected to anal function, and this has not yet been clearly studied. In this textbook, we expand on Shafix’s paper with respect to function and anatomy of the pelvic floor, and concur that his interpretation is also easy to understand for most surgeons.