Posterior proctotomy

Posterior proctotomy is a procedure that was first described more than 100 years ago. Initially, it was the only safe approach to the rectum, but as transabdominal techniques became feasible, the posterior approach was largely abandoned. In recent years, armed with a better understanding of the biological behavior of rectal cancer, surgeons have challenged the concept that 'radical' excision, associated with increased complication rates, always yields improved survival. Posterior proctotomy is an approach that can be considered for the treatment of benign lesions of the distal rectum, for tumors in the presacral space, and for the curative resection of early rectal carcinoma that may be amenable to local excision. As with other local approaches, the key to its successful application is careful patient selection and a willingness on the part of both the patient and the surgeon to convert to a transabdominal approach when adverse tumor characteristics become apparent.