The posterior approach to the low and mid-rectum is a good and anatomi
cal way to treat high fistulas' problems, perirectal tumors and villou
s adenoma. It is also possible to treat by this method some rectal ade
nocarcinomas in special situations and in high-risk patients. A good e
valuation of the disease if possible by rectal endosonography, has to
be done. Coccygectomy is necessary but the transsphincteric route is n
ot mandatory and has never been used here. 9 cases are reported with r
elatively good results.