The usefulness of lithotomy position with the back stretch for operation in the lower rectum

A radiological study was performed to assess the newly devised lithotomy position with the back stretch for obtaining a better surgical field in lower rectal operations. Seven patients undergoing rectal surgery for 2 lesions inthe rectosigmoid colon, 2 in the middle rectum, and 3 in the lower rectum were entered in this study. Plain lateral film photographs of the pelvis were taken in three different positions; supine, lithotomy and lithotomy with the back stretch after marking the pubic bone and introducing the medium into the rectum. Movement of the pubic bone and the distal end of the rectum, and the distance between the distal end of the rectum and the upper end of the pubic bone were evaluated. The operation was performed with the patient in the lithotomy position with the back stretch. The surgeon was interviewed to compare the operative field in the lithotomy position with the back stretch with that of the lithotomy position which had been the standard position. The distance between the distal end of the rectum and the upper end of the pubic bone which can be an indicator of the surgical field was 4.8 cm in the supine position, 8.4 cm in the lithotomy position, and 5.5 cm in the lithotomy position with the ack stretch. The conclusion from the interviews was that the operative field was improved by the new position except in two patients with rectosignoid colon. The lithotomy position with the back stretch was considered to be a useful position for lower rectal surgery.