Sphincter-sparing surgery.

Abstract

Since World War II, a variety of technical innovations have been introduced to preserve the anal sphincter in patients with chronic ulcerative colitis or tumors of the rectum. Studies of anorectal physiology have yielded guidelines for preserving continence and minimizing morbidity. For example, preservation of the anal rectal angle is essential; the rectal mucosa can be removed without impairing neural mechanisms; construction of a reservoir increases rectal compliance. Following these guidelines, surgeons have introduced new techniques and applications benefiting a larger and more varied patient population. Some technical problems remain, however, and patient selection criteria for restorative rectal surgery need to be refined.