Reflections on the technical challenges and strategies in laparoscopic intersphincteric resection
10.7659/j.issn.1005-6947.250512
- VernacularTitle:腹腔镜内括约肌切除术的一些难点问题及思考
- Author:
Wenhao CHEN
1
;
Congqing JIANG
;
Ying HUANG
Author Information
1. 武汉大学中南医院 结直肠肛门外科/低位直肠癌诊治中心/武汉市便秘盆底疾病临床医学研究中心,湖北 武汉 430071
- Publication Type:Journal Article
- Keywords:
Rectal Neoplasms;
Intersphincteric Resection;
Anastomotic Leakages;
Abnormal Defecation
- From:
Chinese Journal of General Surgery
2025;34(10):2084-2094
- CountryChina
- Language:Chinese
-
Abstract:
Laparoscopic intersphincteric resection(ISR)represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer.Based on 400 cases of surgical experience,this study proposes a series of systematic strategies addressing some major technical challenges of ISR.To facilitate precise dissection of the intersphincteric space,a"knife-edge position transanal-priority"approach was adopted,improving exposure and reducing the risk of circumferential margin positivity.To prevent and reduce anastomotic leakage,ISR combined with the modified Bacon(Turnbull-Cutait)delayed anastomosis was introduced as a"stoma-free but safe"alternative.For large anastomotic disruptions,a stoma-therapist-involved management protocol with transanal"U-shaped"repair was implemented to promote healing.Furthermore,a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence.Our initial experience suggests that,these strategies contribute to optimizing the balance between oncological radicality and functional preservation,offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.
