Trans-sphincteric approach to the rectum.

In 28 cases the trans-sphincteric approach has been used to remove lesions of the lower and mid-rectum; in 4 cases the combined abdominal and trans-sphincteric approach was used. Complications were minor and were easily treated and the operation was well tolerated by poor-risk patients. No patient had altered anal continence. The author emphasizes the need for careful identification and reconstruction of the anatomical structures. The trans-sphincteric approach gives excellent exposure of the mid- and lower rectum and has been particularly useful in managing large villous adenomas. The trans-sphincteric approach alone is not adequate for the treatment of cancer, but makes possible sphincter-preserving resections of lesions that might otherwise be treated by more radical procedures.