A new method of colorectal anastomosis in abdominoperineal resection.

Republication of the historical article of Diseases of the Colon & Rectum: Cutait DE, Figliolini FJ. A new method of colorectal anastomosis in abdominoperineal resection. Diseases of the Colon & Rectum. 4(5):335-342, September/October 1961. Read at the meeting of the American Proctologic Society, Pittsburgh, Pennsylvania, June 21 to 24, 1961. † Head of the group in charge of colorectal surgery (Professor Eurico da Silva Bastos). † † Assistant Professor.. * Corresponding author. E-mail: [email protected] (A. da Luz Moreira) 2237-9363/$ see front matter. © 2013 Elsevier Editora Ltda. All rights reserved. http://dx.doi.org/10.1016/j.jcol.2013.12.003 ABDOMINOPERINEAL rectosigmoidectomy is, at present, considered the operative method of choice for treatment of megacolon. This operation is based on the pathogenic basis of dyskinesia of the distal portion of the intestine. According to this theory, dilatation of the sigmoid flexure results from lack of the propulsive function of the rectum and sometimes also of the sigmoid flexure, due to defective contraction of its muscular fibers. The defective contraction is caused by agenesia of the Auerbach’s myenteric plexus in Hirschsprung’s disease and by inflammatory lesions in the acquired megacolon that cause partial or total destruction of the Auerbach’s myenteric plexus. To remedy this condition, removal of the diseased, as well as the dilated portion of colon, with immediate re-establishment of bowel continuity by colorectal anastomosis, seems therefore to be a rational surgical procedure. This is why rectosigmoidectomy has been performed by most experienced surgeons all over the world. Nothwithstanding its effectiveness, there are some restrictions owing to the high incidence of postoperative complications, most of which are due to disruption, of varying degrees, of the colorectal anastomosis. In Hirsch sprung’s disease disruption is rather rare, but in acquired megacolon it is encountered in a large number of cases. In Raia and Haddad’s1 158 patients with acquired megacolon who underwent rectosigmoidectomy, this complication was encountered in 67 cases (42.4 per cent) and in our series of 222 patients it was noted in more than 30 per cent. In our History article