The combined abdominoperineal operation of Miles concededly embodies the best surgical principles known today for the eradication of cancer of the rectum. However, its many disadvantages, such as frequent difficulties in technique, hemorrhage, prolonged operative time, etc., leave much to be desired when one compares it with the more perfected state of many other operations. The second or perineal stage can usually be accomplished quickly and with little difficulty, since the terminal rectum is superficial in the perineum. However, in the abdominal stage the surgeon may be confronted with serious problems when attempting to remove the upper rectum, since not only is this portion of the gastrointestinal tract inaccessible normally but the presence of adherent inflammatory tumors only adds to the problems.
The purpose of this report is to present the advantages of first performing the perineal stage of the combined operation of Miles, thus reversing the order of