ABSTRACT
Determining whether a patient may be a candidate for sphincter preservation (either through trans-anal or trans-abdominal means) usually begins during the patient’s initial assessment. More often than not, the patient comes to the surgeon after having already undergone lower endoscopy. Rectal bleeding may have prompted an evaluation or the patient may have been asymptomatic. Nonetheless, key questions related to the patient’s bowel habits are critical in the assessment. Symptoms of tenesmus often signal the presence of a large tumor which usually requires radical transabdominal surgery. Anal pain, with or without defecation may imply involvement of the anal sphincters or pelvic floor, precluding a sphincter-preserving operation. Patients with fecal incontinence should be identified in the preoperative workup since proctectomy and sphincter preservation may worsen continence, condemning them to significant fecal soilage, even if such a procedure is technically possible.
