INTERSPHINCTERIC RESECTION FOR LOW RECTAL TUMORS

An abdominoperineal operation is described that extends rectal resecti on for low tumours into the intersphincteric plane with removal of the internal sphincter. Bowel continuity is restored by coloanal anastomo sis. Of 38 patients who underwent surgery since 1984, 34 had low recta l cancer and four carcinoid or large villous adenoma. There was no mor tality. Four patients developed local recurrence during a median obser vation period of 3 years. Continence was satisfactory in all patients. The median daily number of bowel movements during the first months af ter colostomy closure was 9 but decreased to 3 after 1 year and 1 afte r 2 years. Anal manometry demonstrated a significant reduction of mean resting pressure from 91.8 to 35.1 cmH(2)O with no recovery after 2 y ears (P < 0.0001). Squeeze pressure showed only a transient decrease.