Surgery

Biography

Biography: Waleed M Ghareeb

Abstract

Problem of the Statement: Transanal Total Mesorectal Excision (Ta TME) approach aimed to overcome pelvic limitation challenges and was easy to locate the lower margin of tumors through the rectal cavity with no guarantee for complete excision of the mesorectal tail. The study aims to identify the start line of Ta TME approach which is corresponding to the endpoint of the mesorectal tail that can guarantee its complete excision.

Methodology: This descriptive study was done on 26 cadavers and 16 post ELAPE surgical specimens. We were first to identify the end of the mesorectal tail (terminal line) then a digital ruler was used to measure the distance between that line and the dentate line and the anal verge to be able to identify the start line transanally.

Findings: Terminal line is an annular pearly white structure at the level of the levator ani muscle hiatus extending from 2 O’ clock to 10 O’ clock posteriorly while couldn’t be found anteriorly. Start line is the intraluminal corresponding line to the mesorectal tail and due to the angulation of the rectum entering the pelvic hiatus the start line is of significantly different distance at 12 O’ clock, 3 or 9 O’ clock and 6 O’ clock directions. The distances to the dentate line in cadavers were 22.85±4.31, 18.35±3.84 and 15.63±3.30 mm, respectively while the in the post-surgical specimens were 28.61±5.43, 21.90±3.58 and 15.63±3.58 mm, respectively with no statistical significance between male and female.

Conclusion: We preliminary concluded that Ta TME start line for mid and low rectal cancer shouldn’t be at the same level due to the angulation of the rectum by the puborectalis anorectal sling making the mesorectal tail end at 12 o’clock direction of a longer distance from the dentate line than its end at 6 o’clock direction which considered of great oncological value.