الفهرس 
Anatomy of the colon and rectumOnly 14 pages are availabe for public view
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Abstract
In our study a total of 40 patients [29 (72.5%) male; 11 (27.5%) female; mean age 54.6±4.3 years] were selected for this prospective study from all patients operated for distal colorectal cancer in our department. Regarding site of tumor, it was in the sigmoid (n=17; 42.5%), rectosigmoid and upper rectum (n=9; 22.5%), and midrectum (n=11; 27.5%) (Figs 5–7). Of the 23 patients with rectal tumors, 18 underwent neoadjuvant chemoradiation (n=18; 78.3%). Patients underwent Sigmoid resection (n=17; 42.5%), anterior resection (n=9; 22.5%), or low anterior resection (n=11; 27.5%) and Ultralow anterior resection (n=3; 7.5%). Thirty one patients (77.5%) operated by open approach and 9 patients (22.5%) operated by laparoscopic resection. Anastomotic leakage was detected in (n=3; 7.5%) on fifth day post operative. Two case were managed conservatively with no intervention, drain stopped after one weak from leak. The other one needed ultrasound guided aspiration. Two cases received neoadjuvant chemoradiation and were diabetic .One case was 63 old age. All three patients were after open surgery and in low rectal tumors.
Genitourinary complication in (n=1; 2.5%). In the form of urinary retention. Frist time of removal of urinary catheter was on 2nd day postoperative and one patient developed urinary retention which regain voiding after catheter reinsertion for 48 hours.
In this patient tumor was in lower rectum and managed by open surgery. Mean ±SD of blood loss during operation (109.5±84.7). The mean number of harvested lymph nodes was 18.17±5.5. Detected Apical lymph nodes mean number (3.1±2.1) with range (0.0 – 7.0). Cases with positive lymph nodes (n= 19; 47.5). Apical lymph node dissection was successful in 38 cases with detection of positive apical lymph nodes in 8 cases (21.0%). Skip metastasis was found in one specimen (2.5 %). No patient in this study needed covering ileostomy. The hospitalization period was 10.6; 4±0.7 days. Five patients had diabetes mellitus, 8 patients were hypertensive and 3 patients were diabetic and hypertensive. Mean operative time was 156.3 ±30.5 minutes. It has been reported that the incidence of anastomotic leakage after surgery for rectal cancer is 5–26 %. Ensuring the anastomosis is tension-free and maintaining blood flow is believed to be important to reduce this incidence. And the level of IMA ligation can determine the ―reach‖ of proximal colon to be anastomosed. High tie, enabling anastomotic tension to be released, is superior to low tie ligation. Low ligation can prolong the reach by increased blood supply; however, in turn, it can hamper the reach by the tension of the mesentery due to the remnant LCA. In addition, it has been reported that the rate of positive lymph nodes at the root of the IMA in patients with rectal cancer is 4.9 % (0.3–11.1 %). A high tie is more likely to damage the nerve plexus around the IMA root, resulting in autonomic nervous system disorders such as urinary dysfunction. Furthermore, it has been reported that blood flow from the IMA is impaired by a high tie and blood flow to the oral side of the anastomosis must rely on the middle colic artery, leading to reduced blood flow. A low tie promotes anastomotic blood flow and oxygenation and reduces the local recurrence associated with suture failure. Based on the previously mentioned, there is a widely accepted operative procedure, low tie with LND around the origin of the IMA. This procedure involves IMA root dissection focusing on the importance of apical LND, which is combined with the preservation of the LCA enabling the important preservation of anastomotic blood flow. This procedure is different from the standard low tie. The incidence of complications other than anastomotic leakage and the length of hospital stay also did not differ.