[Anterior single-stage resection with a manual suture as the standard operation of the proximal and middle third of the rectum]

Of a total of 146 restorative resections 129 one-stage anterior resections were performed in a series of 203 tumours of the rectum. The hand-sutured one-layer anastomosis, well established for the upper third of the rectum, can be equally well effected after resection of the middle third. For this purpose the dissection of the extraperitoneal rectum is carried down as far as to the pectinate line, comparable to the abdominal phase of rectal excision. When the anococcygeal raphe is cut the pectinate line becomes visible upon traction and the anastomosis is readily established from within the abdomen. After release of traction it glides down into it's narrow final embedment in the depth of the pelvis from which a potential dehiscence never becomes apparent before the 7th postoperative day. By this time conservative management without protective colostomy is possible, provided absorbable suture material and adequate drainage are used. Dehiscence rate was 12.4%, operative mortality 1.5%. Single components of reliability of the anastomosis are particularly well visualized and controlled with the hand-suture technique.