Vascular Anatomy of the Rectal Stump After Total Mesorectal Excision

Purpose For many years, poor vascularization of the short rectal stump has been considered the main cause of leakage. The purpose of this study was to evaluate the vascularization of the rectal stump after total mesorectal excision. Methods We studied the iliac vascularization on 28 volunteers with healthy rectum to have an anatomic basis. Then, we studied the vascularization of the rectal stumps after total mesorectal excision by using angio computed tomography at seven and three months after operating on 22 patients; we validated this technique by studying the vascularization using angio computed tomography in 18 rectal specimens from cadavers. Results Both in healthy rectums and in rectal stumps after total mesorectal excision, there is good vascularization substained by middle and inferior rectal arteries. The former is more important and frequent as described in previous literature. Conclusions The vascularization of the short rectal stump is generally well represented even after total mesorectal excision.