THE PARACOCCYGEAL SPHINCTER-SPLITTING MAS ON APPROACH TO THE RECTUM -CAN GOOD RESULTS ONLY BE OBTAINED ON THE BASIS OF HIGHLY SELECTED INDICATIONS

From 3/1985 until 10/1993, a total of 10 patients were operated using the Mason approach. Four patients undergoing resection of flat villous adenomas situated on the anterior wall of the lower and mid third of the rectum, and one patient with adenoma situated on the posterior wal l of the upper third, all of them with reconstruction using intact rec tal wall portions, enjoyed a smooth postoperative course, continence a nd absence of recurrence. Two patients operated for presacral local re currence following rectal excision and rectal prolapse, respectively, suffered recurrence after a smooth early course. Two patients undergoi ng resection of villous adenomas situated on the posterior wall of the lower and mid third with reconstruction using denudated muscle wall a nd one patient undergoing segmental resection for radiogenic rectovagi nal fistula developed complex fecal fistulae. On the basis of these ex periences and the pertinent literature, indications promising uniforml y good results were defined.