To the Editor.—The degree of difficulty in the anterior resection of the rectum is determined primarily by the size and shape of the pelvis and the length of the distal rectal segment. One should preserve every possible centimeter of rectum without compromising the intent of the procedure.
Villous adenomas, small carcinomas, or any soft tumor may be difficult to palpate through the bowel wall, leaving the surgeon with the problem of chosing the proper level of resection. This problem may be easily solved by marking the level of the lesion preoperatively. A sigmoidoscope is passed and a small amount of gentian violet 2% solution or methylene blue 1% solution is injected into the bowel wall at the level of the lesion. At the time of surgery, a highly visible stain will be noted that gives the surgeon the exact location of the lesion.
The device used to deliver the
MINICHAN DP, BARRETT CH. Anterior Colon Resection: A Method of Determining the Level of Resection. Arch Surg. 1978;113(3):342. doi:10.1001/archsurg.1978.01370150114029