Deductions regarding the pull-through operation, based on subjective reactions described by the patients

This report is based on information obtained from 44 patients upon whom I performed pull-through operations for cancer of the rectum. I feel that the results are somewhat discouraging, and I am hopeful that some means to improve them can be established. One discouraging feature is that only 14 (34 per cent) of 44 patients have normal bowel movements without leakage, without the need to wear pads and without enemas. Only 20 (45 per cent) have a sensation of warning before defecation. In some patients in my series the physiology of the anal canal was within the normal range, and possibly some of the sensory nerve fibers were not removed. Apparently it is justifiable to conclude that, to achieve continence, an effort should be made to preserve the epithelium of the anorectal area and the internal sphincter muscle. The operation, in my opinion, is highly selective. It has a place in the treatment of cancer of the rectum. By March 1, 1969, I had performed 102 pull-through operations.