The transsphincteric approach to rectal villous adenomas

In view of the considerable risk of malignancy associated with villous rectal adenomas, treatment is aimed at their complete removal. The transsphincteric approach allows complete excision in the submucosal layer with preservation of the anal sphincter. Six patients are reported in whom this approach was used. Among them were two recurrences, one after a previous transsphincteric operation. In another patient a malignant tumor was detected, necessitating more extensive surgery. A defunctioning colostomy was performed in two cases. Apart from stenosis in one case, no complications occurred. It is concluded that the transsphincteric approach is a valuable asset in the management of rectal villous adenomas. A defunctioning colostomy is not always indicated, especially not if a bland diet is given postoperatively.