Total anorectal reconstruction.

Abdominal stomas carry a considerable physical and psychological morbidity. Several authors have attempted total anorectal reconstruction (TAR) to avoid a permanent stoma for patients undergoing abdominoperineal excision of the rectum (APER). The published series of TAR are reviewed. There is no evidence that TAR adversely affects survival in patients with cancer. Patients who have undergone reconstruction have variable anorectal function, most suffering from anorectal incontinence to some degree. It appears, however, that the psychological benefit of avoidance of an abdominal stoma outweighs the inconvenience of incontinence for almost all. Refinements in surgical technique, allied with novel methods of achieving neorectal emptying, make TAR a viable alternative to APER in selected patients.