Laparoscopically assisted anterior resection for villous adenoma of the rectum

A 57 year old female presented with symptoms from a large, sessile tubulovillous adenoma of the lower third of the rectum. Transanal excision was impracticable due to its size and anterior resection was necessary. The upper third of the rectum was mobilized percutaneously, using the laparoscope. The lower two-thirds of the rectum were mobilized transanally and a non-everted pull-through excision of the lower third was performed, with a hand sewn colo-anal anastomosis. A temporary loop ileostomy was established through a 2.5 cm abdominal incision. Postoperative recovery was uncomplicated. The operative technique, which may have other applications, is described in detail.