ABSTRACT
The optimal management of rectal cancer, particularly low rectal cancer,* presents a unique challenge. The goal of an ‘RO’ excision is the main aim of radical surgery, but wide excision may involve sphincter damage, impairing a patient’s quality of life. In Europe trans-sacral rectal excision was explored and popularised. Originally described by Kocher in 1875, the technique was popularised by Kraske. The patient was placed on the side, and a vertical incision was made from behind the anus, over the sacrum, usually inclining to one or other side of the mid-line. Maunsell described a method of restoring bowel continuity in an upper rectal cancer in 1892; the method involved suturing the bowel from within the lumen. Kraske described a similar technique to Maunsell’s anastomosis that involved suturing the colon to the anorectal stump after the rectum had been removed via the sacral route.
