Transabdominal sacrorectal resection is a rectal cancer resection procedure invented by Hartmann in 1923. It is suitable for rectal cancer of 7~300px on the dentate line in men and 6~275px on the dentate line in women. It is especially suitable for the following patients: ①Patients with poor general condition or serious diseases of heart, lung, liver and kidney, who cannot tolerate larger surgery. ②Patients with advanced age and frailty, with significantly weakened anal contraction ability, but with early stage of cancer and poor anal control of stool after performing anal preservation surgery. ③ Those who have serious local lesions of rectal cancer and still have cancer residue in the pelvic cavity after separation, or those who have serious metastasis in the lateral lymph nodes in the pelvic cavity and incomplete removal, but need to end the operation as soon as possible. The abdominal surgical incision, freeing the sigmoid colon and rectum, and the method and scope of lymphatic removal are the same as Miles surgery. 1.Anesthesia and position General anesthesia is used, and the surgical position is a right lateral position with the right leg bent nearly 30 degrees. The abdominal and sacral surgeries can be performed simultaneously, and there is no need to change the position if Miles or Dixon surgery is needed during the operation. 2.Incision The abdominal incision is made from the intersection of the left anterior axillary line and the rib arch, and reaches the midpoint of the pubic symphysis via 50px above the groin. The sacrococcygeal incision is a transverse incision in the sacrococcygeal union, about 6-175 px long. the caudal bone is excised and communicates with the abdominal incision in the anterior sacral area. 3.Exploration The method is the same as Miles procedure. The jejunum was placed in an intestinal pouch and placed outside the incision. The lateral peritoneum of the sigmoid colon and descending colon is incised, and the splenic flexure of the colon is fully freed. Care is taken to protect the left ureter. Ligate and cut the inferior mesenteric artery from the root, and ligate and cut the left colonic arterial and venous trunks. Protect the marginal arterial arch of the colon, and ligate the intestinal canal with gauze strips at the proximal end of the sigmoid colon where blood flow is good. After that, the pelvic floor peritoneum on both sides of the rectum was incised, and the scope of free rectum was the same as that of Dixon’s operation. 4.Excision of the cancerous intestinal canal for colorectal anastomosis The sacrococcygeal area was re-sterilized and toweled. A transverse sacrococcygeal incision was made, the size of which could accommodate a one-handed fist to connect with the abdominal incision. The gauze strip ligating the intestinal canal is clamped with hemostatic forceps, and the colon and the mass are pulled out from the sacrococcygeal incision (Figure 7-24). Two large right-angle forceps are placed on the proposed anastomosis at the upper end of the sigmoid colon and the sigmoid colon is severed. In the unstressed state, another large right-angle clamp is placed 75 px below the lateral edge of the cancer anus to cut the rectum. After the rectal cavity is flushed through the anus, rectal-colonic anastomosis is performed, the intestinal tube is returned to the pelvic cavity, the pelvic cavity is thoroughly flushed, and a drainage tube is left in front of the sacrum for transsacral proctocolectomy, which has the following advantages: ① Eliminates the need for more complicated operations in the pelvic cavity. ②No perineal surgery. ③Reduced bleeding. Therefore, the operation time is shortened and the postoperative recovery is fast.