Surgical aspects of rectal reconstruction: Alternatives for ultralow anastomosis

Various surgical alternatives are routinely used for neorectal reconstruction, although the medium- and long-term data concerning functional bene fit is debatable. Poor functional outcomes and the incidence of low anterior resection syndrome are likely more common than reported. The causes of these problems are complex and include anastomotic dehiscence, perianastomotic sepsis, poor pouch volumes, sphincter damage during reconstruction, and the effects of radiation on the sphincter mechanism. The increasing trend toward sphincter preservation has made the assessment and reconstruction of complicated cases more important in clinical practice and has highlighted a greater emphasis on more objective assessments of postoperative quality of life parameters. This chapter outlines the data pertaining to functional outcome after low restorative proctectomy, compares the different methods of rectal reconstruction, and addresses the management approach in dif ficult cases.