A new lease on life- Sphincter Preserving Surgery

Dr. Ashvin Rangole (Sr Consultant – Surgical Oncology)

SRJ – CBCC Cancer Hospital, Indore, recently conducted a successful Sphincter Preserving Surgery or an ISR. 

The case belonged to a 35 year old female who was presented with a history of bleeding from rectum. She underwent a proctoscopy at CBCC hospital, a procedure to examine the insides of  rectum and anus. The examination revealed an ulcerative lesion involving anorectum which was about 2.5 – 3 cm from anal verge and distal rectum. Colonoscopy, another type of examination, did not show any synchronous lesions.

The case was performed by Dr. Ashvin Rangole, a Senior Consultant Surgical Oncologist with 15 years of Oncology practice. A member of Indian American Cancer Association, he received ‘Excellence in Oncology’ award in 2017.  He has performed the 2nd HITHOC (Hyperthermic Intrathoracic Chemotherapy) procedure in India for Pleural Cancer, he was also an invited speaker on the topic of HIPEC at World Cancer Congress – 2017, which happened in Barcelona, Spain. He has now developed interest and expertise in sphincter preserving procedures for carcinoma anorectum.

The patient was diagnosed with a well differentiated Adenocarcinoma rectum or rectal cancer. She was advised for CT Thorax/Abdomen with contrast and MRI pelvis. The CT Scan showed absolutely no other significant higher nodal & visceral diseases.

The patient was subjected to neoadjuvant chemoradiotherapy, in view of locally advanced disease by virtue of mesorectal lymphadenopathy. After 7 weeks, she was evaluated by MRI pelvis & PET CT Scan which confirmed residual ulcer in anorectum. Her internal sphincter was also free of diseases. The patient was later counseled for an option of sphincter preserving rectal surgery/abdominoperineal resection. She was clearly made aware and understood the benefits as well as the risks of the procedure. After proper counselling, the patient willingly agreed for the sphincter preserving surgery.

Soon, she was admitted and all routine and specialized tests were administered to assess her various body organ functions. She underwent anterior resection of rectum with intersphincteric resection (preserving external anal sphincter). She was then re-evaluated with abdomen/pelvis distal cologram, per rectal examination and anorectal manometry to assess disease status and stool continence. With proper guidance , she was taken for ileostomy closure and later on was advised to continue kegel exercises that strengthened her pelvic floor muscles which supports the uterus, bladder, small intestine and rectum to improve continence.

After mild stress and initial frequency of motion, her continence improved. The patient has been living a disease-free life for three years now.

The Team Cares 

At SRJ – CBCC Indore, our well trained and experienced doctors, like Dr. Ashvin Rangole’s first priority is the precise diagnosis of the ailment and treatment for the same. We at CBCC are dedicated to providing comprehensive diagnostic, interventional, surgical, and preventive services for all patients regardless of age, complexity, or severity of their condition. 

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