ABSTRACT
The advent of circular stapling instruments and advanced surgical techniques has resulted in sphincter-saving rectal resections becoming common practice in the surgical management of both benign and malignant rectal pathology. Using abdominal approaches to rectal resection further improvements in the rates of anal sphincter preservation for distal rectal pathology are limited by anatomical considerations. A number of additional surgical techniques have been developed to be used in combination with an abdominal approach to effectively excise rectal pathology while preserving the anal sphincter complex. Historically, these include abdominoanal pull-through, parasacral and abdominotranssphincteric techniques. More recently, intersphincteric resection has been introduced. However, such techniques are often associated with significant morbidity and poor, even unacceptable functional outcome following inadvertent or intentional injury to the anal sphincter complex.
