Application of laparoscopic intersphincteric resection by transanal specimen eversion combined with modified Bacon operation in ultra-low anal preservation for lower rectal cancer(report of 6 cases)

LI Jiaze; WANG Wuyi; RUI Yuanyi; YI Bo; CHEN Chao; FENG Xiaopei; ZHANG Jingbo; ZHENG Yangchun

doi:10.3969/j.issn.1674-3806.2024.05.03

Abstract：Objective To explore the application of laparoscopic intersphincteric resection(ISR)by transanal specimen eversion combined with modified Bacon operation in ultra-low anal preservation for lower rectal cancer.Methods The clinical data of 6 cases with lower rectal cancer who underwent laparoscopic radical resection and ultra-low anal preservation with ISR by transanal specimen eversion combined with modified Bacon operation in the Department of Color-ectal Surgery of Sichuan Cancer Hospital from March 2023 to December 2023 were retrospectively analyzed.The short-term clinical effects were explored and the surgical skills were summarized.Results All the operations were accom-plished successfully in the 6 patients,with operation durations ranging from 200 to 320 minutes and an average duration of 256.7 minutes.Intraoperative blood loss ranged from 20 to 100 milliliters,with an average blood loss of 48.3 milliliters.After operation,1 patient developed prolapse of the external intestinal segment and underwent reoperation for resection,and 2 patients developed local mesenteric ischemia of the external intestinal segment and improved after conservative treatment.All the patients recovered successfully and were discharged from the hospital 6 to 11 days after operation,with an average postoperative hospital stay of 8.2 days.All the patients underwent second-stage external intestinal segment resection and anoplasty 21 days after surgery,and were discharged from the hospital 3 to 6 days after operation,with an average postoperative hospital stay of 4.3 days.All the patients were followed up until March 2024,and no tumor recurrence and metastasis were observed,and Wexner incontinence scores ranged from 1 to 5 points 3 months after the second-stage operation with average scores of 3.2 points,and the anal continence function was satisfactory.Conclusion Laparoscopic ISR by transanal specimen eversion combined with modified Bacon operation can help to achieve accurate resection of distal tumors,can greatly reduce the operational difficulty of transanal resection and avoid preventive enter-ostomy,and the postoperative anal function is satisfactory,which is expected to become a new choice for ultra-low anal preservation surgery for lower rectal cancer.