PERINEAL EXCISION OF THE RECTUM

An intersphincteric and perimuscular approach was employed for perinea l excision of the rectum in 33 patients who had previously undergone t otal colectomy with preservation of the rectum. Laparotomy was avoided in 28 of the 29 patients who had had closure of the rectal stump with ileostomy. Of the four patients (two with ileorectal anastomoses and two with sigmoid mucous fistulas) for whom laparotomy was planned, thi s was considered to be much less extensive than would otherwise have b een required. It is concluded that in patients who have previously und ergone total colectomy for inflammatory bowel disease, subsequent peri neal excision of the rectal stump without laparotomy is frequently pos sible.