الفهرس 
Surgical anatomy of the rectumOnly 14 pages are availabe for public view
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Abstract
Laparoscopy has improved the surgical treatment of various diseases due to its magnified vision and less traumatic surgery has developed as an interesting therapeutic alternative for open rectal surgery. The applicability of laparoscopy to rectal cancer surgery continues to expand.
In laparoscopic management of rectal cancer, it is important to standardize the preoperative and the postoperative care plans, so that optimal results can be obtained. Also appropriate patient choice and differences in surgical techniques or surgeon’s skills may account for the great variability in outcome.
Laparoscopy alone can hardly match the outcomes of ‘fast-track’ open rectal surgery, but on the other hand the laparoscopic approach should be considered as a main element of an enhanced recovery program, at least in rectal cancer cases.
In rectal cancer, technical difficulties as well as doubt on oncological clearance had once limited sphincter preservation to carcinomas located at the recto sigmoid junction or in the upper rectum. Progress in technology and skills, however, has finally led to the controversial extension of minimally invasive tech¬niques to distal rectal cancer with sphincter preservation.
Laparoscopic rectal cancer surgery has been shown to be safe, with equivalent local recurrence and long-term survival rates to conventional open surgery and better short-term patient outcomes. However, Laparoscopic rectal cancer surgery tends to require more operating theatre time and disposable equipment. The negative effect of the prolonged operating time in laparoscopic rectal surgery is overrun by short-term advantages such as decreases in-hospital stay, wound infection, postoperative ileus and postoperative pain.
The magnified vision and less traumatic surgery offered by the laparoscopic approach may allow better preservation of the pelvic autonomic nerves and presumably, better preservation of quality of life and fewer urinary, sexual, and bowel dysfunctions following laparoscopic surgery for rectal cancer compared to open surgery. However, conflicting results have been reported in the literature
Generally laparoscopic management of rectal cancer has a lot of short outcomes advantages including faster recovery decreased postoperative pain, early discharge from the hospital, less duration of postoperative ileus, less postoperative adhesions, less morbidity, less wound infection, less intraoperative blood loss, less abdominal hernia and improved cosmoses. There are well-documented complications such as vascular Injuries, bowel and organ Injuries, anastomotic leak, thromboembolic complications and port site herniation or recurrence. These are for the most part avoidable with good technique.
Finally, low rectal resection carries the highest conversion rate with negative impact on survival and morbidity outcomes. Studies confirm that there is a decrease in the conversion and complication rates in high-volume hospitals with increasing experience and specialization in laparoscopic rectal surgery.