Many series of this procedure report recurrence in up to 36 percent and significant complication in up to 19 percent of patients. Transanal endoscopic microsurgery has achieved recurrence rates of 2.8 percent and low complication rates but for economic reasons has failed to find a widespread role. This article demonstrates that large, villous tumors of the low and mid rectum can be simply and effectively treated by per-anal resection with recurrence rates equivalent to transanal endoscopic microsurgery.
Seventy-seven consecutive low anterior resections of the rectum were performed with a selective approach to the use of a defunctioning colostomy. A defunctioning colostomy was performed in seven patients (9 per cent) where there was concern about the anastomosis due to difficult dissection (three), incomplete doughnuts (three) and tension on the anastomosis (one). The mean level of the tumour in the defunctioned group was 7.6 cm. Clinical anastomotic leakage occurred in two patients (3 per cent) in the non-defunctioned group, both of which were controlled with subsequent transverse colostomies. There were no perioperative deaths. Selective defunctioning of low colorectal anastomoses can produce low rates of anastomotic dehiscence while reducing the morbidity associated with a temporary stoma.
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