[Colo-anal anastomosis, a strong competitor of preternatural anus]

A colostomy after a rectum amputation has great impact on a patient's lifestyle. An alternative that can restore anal defaecation after rectum extirpation for low-seated lesions is attractive if the method does not increase mortality or morbidity, if functional results are good and if oncological principles can be maintained. In selected cases a colo-anal anastomosis after rectal excision can be an alternative to a colostomy. The technique originates from pouch-anal anastomosis techniques after total proctocolectomy for ulcerative colitis and familial polyposis coli. Based on the literature and the results of seven of our own patients the method, its complications, its functional results and the oncological consequences are discussed. The conclusion is that in selected cases of rectal carcinoma the method can prevent a colostomy without increasing morbidity or mortality, with good functional results and according to oncological principles. Especially when a lesion is located distally in the rectum, the method is often applicable when a low anterior resection is not, or technically easier than a low anterior resection.