Functional results of rectal excision and endo-anal anastomosis

Twelve consecutive patients have been treated by rectal excision and endo-anal anastomosis since March 1978. Eight operations were for invasive carcinoma; extension into perirectal fat was recorded in all except one patient and early recurrence was observed in 3(6, 9 and 14 months after operation). Two operations were for carcinoma complicating extensive villous adenoma and 2 further patients underwent the procedure for excision of a Crohn's stricture. In the first 6 months after operation, stricture of the "neorectum' was observed in 7 of 8 patients and was associated with urgency of defecation in 6. Manometric studies indicated that although normal sphincter pressures were maintained, the capacity of the "neorectum' was significantly reduced at 6 months compared with preoperative values (P < 0.01). At 12 months only 3 of 6 patients still had a stricture, with urgency in 2. Complete continence was reported in all except one patient.