Babcock used to complete the resection by posterior access to the

Babcock used to complete the resection by posterior access to the pelvis, sectioning the sphincter and better the levator ani, then he proceeded to reconstruction by means of P-T, leaving in place the anal epithelium. Bacon instead, was used to remove the mucosa of the anal canal along with the internal sphincter, with the aim of obtaining a quicker and safer sealing of the exteriorised colon. Initially he too used to section the external sphincter then, in the following years, described the respect of both sphincters. These techniques (known as Babcock-Bacon P-T) had large diffusion in the 50s in the anglosaxon countries. Their rationale was to perform a restorative procedure but with the same finalities of clearance and eradication as the Miles�� procedure, which is the excision of the whole rectum together with the resection of the pelvic fascia and diaphragm, and dissection of the ischio-rectal fossae.

The functional results of this procedure, as firstly reported by the Authors, could no longer be reproduced, and this induced to modifications then described by Black (10), Toupet (11), by Cutait (12) and contemporarily by Turnbull (13). However, even though not free from morbidity and consequences, with cramped and often incomplete recovery of continence, the method of P-T had success until the whole 70s for the acknowledged merit of making the construction of distal anastomoses easier, and additionally making possible the fashioning of an immediate but also of a delayed anastomosis.

A delayed reconstruction was fashioned by maintaining the distal end of the colic stump exteriorised through and beyond the anus, for the time necessary to the healing of an upstream anastomosis between a cranial portion of the colonic stump and the rectal residue or the anal canal. It was thus possible to achieve the double goal of avoiding a protective stoma and minimizing the risk (and relative consequences) of a dehiscence. In the 80s the improved knowledge of anorectal physiology and above all the advent of mechanical staplers conditioned the rapid decline of P-T (14), which reduced to few indications and was also forgotten in the scientific reports as many surgeons from the last generations did not have any knowledge of it, neither direct nor historical (the last generations had their training in schools where P-T was never utilized). Besides, when checking recent publications of large series of rectal resections, we realize that many cases of immediate coloanal anastomosis (I-CAA) are reported Entinostat as still fashioned by P-T, but called otherwise (15, 16). The little interest dedicated to the topic may also have put under silence further evolutions of the procedure.

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