A sphincter-preserving operation that aims to improve quality of life (QoL) must also be safe to perform with a low mortality and morbidity and must give a satisfactory functional result.
It is well known that APR is associated with a significant complication rate both related to the per-ineal wound and the abdominal stoma. In a recent study  the overall complication rate was reported to be about 60%, the most frequent being urinary tract problems and perineal wound infections. However, even AR proved to be afflicted with an overall complication rate approaching 40%; anastomotic leakage and pelvic sepsis (10%) being the most frequent. However the adoption of the TME technique leads to an increasing number of low and ultralow colorectal anastomoses and with them an increased complication rate, as reflected in a report from Karanjia et al. . The leakage rate in this study was 18%, mostly in patients with an anastomosis fashioned below 6 cm.
Major leaks occurred in 24 of the 219 patients in the study. Three of these patients died and the remaining 21 patients ended up with a permanent stoma. Mortality rates after the two operations seem to be similar, ranging between 2 and 3% .
It should be emphasised however that APR and AR are technically and anatomically quite different procedures and therefore not comparable. Problems related to the perineal wound after APR add considerably to the morbidity.
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