Our Summary

This research paper discusses a surgical procedure called “total mesorectal excision” (TME), which is the main method for treating rectal cancer. This procedure is usually clean, but it can potentially damage important nerves and blood vessels, especially in patients with inflammation in their lower colon and rectum.

To limit the damage, a less aggressive form of surgery known as “close rectal dissection” has been suggested. The researchers reviewed the history and evolution of this procedure, as well as how it’s used in less invasive surgeries today.

They found that this modified approach, which has been used since 1956 and adapted for use in laparoscopic (minimally invasive) surgery, could be especially helpful in certain types of rectal surgery. It has been reported to result in fewer nerve injuries and less infection in the pelvic area. However, this approach also carries risks, such as bleeding, rectal injury, and ongoing inflammation from any remaining diseased tissue.

In conclusion, the paper suggests that in cases of inflammation, close rectal dissection could be a useful alternative for surgeons, as it might reduce complications and improve patient recovery after surgery.

FAQs

  1. What is “total mesorectal excision” and when is it typically used?
  2. What is the “close rectal dissection” surgical method and how does it differ from total mesorectal excision?
  3. What are the potential risks and benefits of using the close rectal dissection method for rectal surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to discuss with their surgeon the possibility of using a modified approach such as close rectal dissection to potentially reduce the risk of nerve damage and other complications. It is important for patients to have an open and honest conversation with their healthcare provider about the best surgical approach for their individual situation.

Suitable For

Patients who are typically recommended for proctectomy, or surgical removal of the rectum, include those with rectal cancer, inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), and other conditions that affect the rectum and lower colon. In cases where inflammation is present in the lower colon and rectum, the modified approach of close rectal dissection may be recommended to reduce the risk of nerve damage and other complications associated with traditional total mesorectal excision surgery. This approach may be especially beneficial for patients with inflammation in the pelvic area, as it has been reported to result in fewer nerve injuries and less infection. Ultimately, the decision to recommend proctectomy and the specific surgical approach will depend on the individual patient’s condition and the expertise of the surgical team.

Timeline

  • Before proctectomy:
  1. Patient is diagnosed with rectal cancer and undergoes various tests to determine the extent of the disease.
  2. Patient meets with a colorectal surgeon to discuss treatment options, including the possibility of a proctectomy.
  3. Patient undergoes pre-operative preparation, which may include bowel preparation and other tests to ensure they are fit for surgery.
  • During proctectomy:
  1. Patient undergoes the surgical procedure, which involves the removal of the rectum and possibly the surrounding tissues.
  2. Surgeon may perform a total mesorectal excision or a close rectal dissection, depending on the specific case.
  3. Patient is monitored closely during and after the surgery for any complications.
  • After proctectomy:
  1. Patient is closely monitored in the hospital for a few days to ensure proper healing and recovery.
  2. Patient may experience pain, discomfort, and changes in bowel function in the immediate post-operative period.
  3. Patient undergoes follow-up appointments with the surgeon to monitor healing and discuss any concerns.
  4. Patient may require additional treatment, such as chemotherapy or radiation therapy, depending on the stage and extent of the cancer.
  5. Patient undergoes rehabilitation and support to help them adjust to any changes in bowel function and overall quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about proctectomy include:

  1. What are the potential risks and complications associated with a proctectomy procedure?
  2. How will my quality of life be impacted after the surgery?
  3. What is the difference between total mesorectal excision and close rectal dissection, and which approach do you recommend for my specific case?
  4. How experienced are you in performing proctectomy surgeries, and what is your success rate?
  5. What is the expected recovery time and rehabilitation process after the surgery?
  6. Will I need any additional treatments or therapies after the proctectomy?
  7. How will my bowel function be affected after the surgery, and are there any strategies to manage potential changes?
  8. What long-term effects or complications should I be aware of post-proctectomy?
  9. Are there any specific dietary or lifestyle changes I should make before or after the surgery?
  10. Can you provide me with any additional resources or information about proctectomy and my specific condition?

Reference

Authors: Nally DM, Kavanagh DO, Winter DC. Journal: Surgeon. 2019 Apr;17(2):119-126. doi: 10.1016/j.surge.2018.06.002. Epub 2018 Jul 18. PMID: 30031668