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August 18, 1951

PHYSIOLOGICAL BASIS FOR PRESERVATION OF FECAL CONTINENCE AFTER RESECTION OF RECTUM

Author Affiliations

Framingham, Mass.

From the Department of Surgery, Boston University School of Medicine, and the Surgical Service of the Framingham Union Hospital.

JAMA. 1951;146(16):1486-1489. doi:10.1001/jama.1951.03670160028008
Abstract

Preservation of the anal sphincters in resection of the rectum can have but one aim, the retention of fecal continence. If this aim is to be realized, the mechanism by which fecal continence is normally maintained should be understood. The experimental work of McVay,1 Gilchrist and David,2 Glover and Waugh3 and others4 indicates that lymphatic metastasis from cancer of the rectum does not take place in a retrograde or distal direction until the proximal nodes lying in the mesosigmoid are largely blocked by malignant cells and the lymph stream thereby forced into collateral channels. On the basis of this work some surgeons have concluded that it is both safe and desirable to preserve the anal sphincters when resecting the rectum for malignancy. Other surgeons have violently disagreed with this view on the basis that the less radical, sphincter-preserving operation will result in fewer cures. The purpose

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