Rectal resection for tumour with transanal anastomosis and sphincter preservation

Resection of the rectum, with restoration of continuity by means of a primary, transanal, anocolic anastomosis, is a useful method in the treatment of certain rectal tumours. It particularly fills a need in the management of tumours of the lower rectum where anterior resection is indicated but is technically difficult and liable to complications, or where it is not possible and would be abandoned in favour of abdominoperineal excision of the rectum with a permanent colostomy. The pathological criteria, technical factors and functional results which justify the use of this procedure are discussed. The principles of the operation are described, and 2 illustrative cases are reported. The large size, low site and pathological nature of both the malignant carcinoid tumour and the leiomyoma were such that total rectal resection was obligatory, the object being palliation in the former and cure in the latter. Both patients were continent after the operation. The place of this operation in the treatment of adenocarcinoma of the rectum is discussed.