AS A CONSEQUENCE of modern surgical and anesthetic advancement, there are greater opportunities for the salvage of life. Without in any way sacrificing the effects of these advancements, the surgeon then looks to further refinements which give, not only salvage, but also a greater measure of anatomic, physiologic, and sociologic reconstruction, restoration, and rehabilitation. In the field of rectal surgery, even salvage was rarely possible until the worldwide adoption of the Miles operation for rectosigmoid and rectal cancer. Subsequently, careful dissections of pathologic specimens, along with lymphnode clearance studies gave laboratory evidence, at least, that the sphincters need not be sacrificed in the interest of salvage for lesions above 4 to 5 cm, since retrograde lymphatic spread was rare in the absence of widespread disease.3 This information, along with the desire to achieve more restorative results, led to the development of numerous sphincter-saving procedures.
The simplest and oldest of
BERNHOFT WH, PORTIN BA. Low Rectal AnastomosisModified Pull-Through Procedure. Arch Surg. 1965;90(1):123-126. doi:10.1001/archsurg.1965.01320070125027