Application of double-entry approach in laparoscopic lower rectal sphincter preservation for rectal cancer with splenic flexure

Abstract

Objective To summarize the experience and value of laparoscopic double-entry in sphincter preserving surgery for rectal cancer with free splenic flexure. Methods The clinical data and short-term follow-up results of 38 patients who underwent anal sphincter preservation of the rectum with laparoscopic surgery of the colon by double-entry laparoscopy performed by the same group of surgeons from April 2016 to September 2017 were analyzed retrospectively. Results All the operations were successful and none of the patients were converted to open surgery. There was no left ureter, left kidney, spleen and pancreas injury in the operation. The mean operation time was 142.4±35.3 min, mean blood loss 98.7±34.5 ml, mean specimens 21.1±6.7 cm, mean tumor resection margin 4.5±2.8 cm. The mean number of lymph nodes harvested was 12.7±6.3, mean postoperative exhaust time 3.6 ±1.7 day, and the mean hospitalization time was 12.4±3.2 day. There were four (10.5%) postoperative complications including two (5.26%) incision infection, one (2.63%) urinary retention and one (2.63%) pulmonary infection. No complications such as anastomotic leakage and anastomotic bleeding occurred. All patients were followed up so far, no tumor recurrence. Conclusion The double-entry approach is accurate, anatomical and easy to master in laparoscopic anus preservation for rectal cancer with splenic flexure. It is worthy of popularization and application. Key words: Rectal neoplasms; Double-entry approach; Splenic flexure; Preserving anus; Retrospective analysis