LAPAROSCOPICALLY ASSISTED ANTERIOR RESECTION FOR VILLOUS ADENOMA OF THE RECTUM

A 57 year old female presented with symptoms from a large, sessile tub ulovillous adenoma of the lower third of the rectum. Transanal excisio n was impracticable due to its size and anterior resection was necessa ry. The upper third of the rectum was mobilized percutaneously, using the laparoscope. The lower two-thirds of the rectum were mobilized tra nsanally and a non-everted pull-through excision of the lower third wa s performed, with a hand sewn colo-anal anastomosis. A temporary loop ileostomy was established through a 2.5 cm abdominal incision. Postope rative recovery was uncomplicated. The operative technique, which may have other applications, is described in detail.