ABSTRACT
A colorectal anastomosis is constructed using a circular stapling device, which allows tumours closer to the anal margin to be removed in this way. Anterior resection of the tumour with total mesenteric excision (TME) is the gold standard for the treatment of cancer in the upper two-thirds of the rectum. It cannot be used if the tumour is close to or involves the anal sphincter complex. The patient is positioned in the extended Lloyd–Davis position under general anaesthetic with a urinary catheter inserted. At the distal end, the mesorectum is dissected from surrounding fascia on all sides along a loose areolar plane. The lesion can be excised using a transanal endoscopic microsurgery (TEM) technique. This utilises a specialised operating proctoscope that allows distension of the rectum with gas and passage of instruments. The irreversible nature of the colostomy should be discussed with the patient and their family.
