Kraske's posterior approach to the mid rectum; does it still have a place in the surgeon's armentarium?

Abstract

Between 1983 and 2006, 24 patients with rectal lesions were treated by Kraske's posterior approach at the 4th department of surgery of Evangelismos Hospital and Athens Medical Center. Ten were male and 14 female. Their age ranged from 36-81 years (M: 61,2 years). The pathology of the treated lesions included: 5 villous adenomas,6 tubular adenomas, 5 tubulovillous adenomas,1 benign stenosis,1rectovaginal fistula and 6 adenocarcinomas of the rectum. One patient died from massive pulmonary embolism, the first postoperative day after a defunctional colostomy for a proctocutaneous fistula. The postoperative complications included 2 proctocutaneous fistulas, 1 wound infection and minor incontinence in one patient which recovered spontantaneously. The postoperative follow up period varied from 6 to 60 months (M:37,8 months). Only one recurrence was observed in a patient who had an infiltrative adenocarcinoma. It is concluded that Kraske's procedure is easy to perform and it is suitable for elderly patients who cannot tolerate a major operation or for cases where complete excision of a benign lesion and in carefully selected cases of a malignant lesion, cannot be safely performed endoscopically or transanally.