Modification of the hochenegg pull-through operation for carcinoma, papillary adenoma and lymphogranuloma

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Abstract
Conclusions Although this series of patients is too small to warrant reliable conclusions, it does, however, reveal some pitfalls with respect to the selection of operative procedures. It brings into focus the absolute necessity of providing sufficient mobilization of the bowel to ensure that it lies freely in the hollow of the sacrum with no tension on the bowel or marginal vessels. This series of operations indicates that the pull-through operation has a definite, though limited, application in pathologic involvement of the rectum, especially in cases where the bowel can be cut across at least 5.0 cm. below the cancer. If this cannot be done, an abdominoperineal resection with permanent colostomy should be performed. If the tumor is high enough in the rectum to permit an intra-abdominal anastomosis after dividing the bowel 5.0 cm. below the tumor, this is preferable. If complete fecal control is expected, it is important to retain the levator ani muscles and the internal and external anal sphincters.

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