Progressive release of the left colon for a tension-free colorectal or coloanal anastomosis
Resection of the rectum, sigmoid colon, or the entire rectosigmoid colon is necessary for multiple malignant and noncancerous conditions. Perhaps the most common indication is carcinoma of the rectum or rectosigmoid colon. Sometimes, extensive diverticular disease of the colon requires a resection from beneath the peritoneal reflection to the junction of sigmoid and descending colon. In patient’s with peritoneal carcinomatosis from pseudomyxoma peritonei or from ovarian cancer, the cul-de-sac of Douglas and rectosigmoid colon up to the level of the descending colon are heavily involved by the spread of cancer. In order to avoid persistent disease in the pelvis, a complete pelvic peritonectomy is required, including resection of the rectosigmoid and sigmoid colon. In all these instances, adequate vascularity of the distal sigmoid colon and a tension-free anastomosis are requirements for a complication-free procedure. The dissections that can be used to create a tension-free anastomosis are described.
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