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Video

Session: Ongoing Videos

VM19 - Pushing Surgical Boundaries: Intersphincteric Ultra-Low Anterior Resection for High-Grade Dysplastic Tubulovillous Adenoma – A Case of Precision and Success

ONGOING VIDEOS
Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Bertha Alicia A. Dimas Sanchez, MD (she/her/hers)

    PGY-6
    Hospital General de México
    Universidad Nacional Autónoma de México
    Ciudad de México, Distrito Federal, Mexico

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Jeziel Karina Ordonez Juarez (she/her/hers)

    Resident
    Hospital general de México
    Universidad Nacional Autónoma de México
    Mexico, Mexico

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • BJ

    Billy Jimenez-Bobadilla, M.D.

    Colon & Rectum Surgeon
    Hospital General de México
    Ciudad de México, Distrito Federal, Mexico

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Rodolfo R. Sánchez Rosado

    Residente
    Hospital General de México
    Hospital General de México
    mexico, Distrito Federal, Mexico

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • AI

    Ana Jimena Iberri Jaime, MD, Colorectal Surgeon

    Associate Profesor
    Hospital General de México "Dr. Eduardo Liceaga"
    Mexico City, Distrito Federal, Mexico

    Disclosure information not submitted.

  • MP

    Mildred Philippe Ponce, 9354604

    Colorectal Surgery Resident
    Hospital General de México
    Ciudad de México, Distrito Federal, Mexico

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Bertha Alicia A. Dimas Sanchez, M.D.: This individual has no financial relationships with ineligible companies.
Jeziel Karina Ordonez Juarez: This individual has no financial relationships with ineligible companies.
Billy Jimenez-Bobadilla, M.D.: This individual has no financial relationships with ineligible companies.
Rodolfo R. Sánchez Rosado: This individual has no financial relationships with ineligible companies.
Mildred Philippe Ponce, 9354604: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The ultra-low anterior resection is a conservative surgical technique designed for patients with low rectal cancer, allowing for the preservation of sphincter function. This approach is crucial for individuals with neoplasms located near the anal margin, where maintaining continence is essential to post-surgical quality of life.

Methods/Interventions: The patient was initially diagnosed with a non-stenosing low rectal adenocarcinoma, situated 4 cm from the anal margin, and classified as clinical stage I. A colonoscopy confirmed the presence of the lesion, prompting the decision to proceed with surgery due to the high grade of dysplasia.

Surgical Technique and Procedure:
An ultra-low anterior resection with partial intersphincteric resection and end-to-end coloanal anastomosis was performed. A loop ileostomy was used as a protective measure. Early intestinal transit was restored using a mechanical isoperistaltic side-to-side entero-entero anastomosis. Additionally, anal exploration under anesthesia was performed to remove suture material and staples causing mild anal stenosis. All procedures were conducted under safety protocols using a laparoscopic approach.

Results/Outcomes: The patient showed marked improvement in quality of life and a reduction in anorectal dysfunction symptoms. Postoperative assessments confirmed the integrity of the coloanal anastomosis and successful treatment of the anal stenosis. Adjustments to the patient’s medication were made to manage residual symptoms of LARS.

Conclusion/Discussion: he ultra-low anterior resection, followed by the restoration of intestinal transit, was effective in preserving anorectal function while ensuring the eradication of rectal carcinoma.