Posterior sagittal approaches allow complete anatomic exposure of the perineum and lower pelvis. Moreover, they reduce the risk of damaging important structures because the incision is led in the midline. Objective: To evaluate feasibility and efficacy of removal of a small malignant tumor in the lower rectum through a posterior sagittal approach. Patients and methods: Between March 2007 to May 2010, twenty one patients (12 males and 9 females) mean age 52.3 years were submitted to posterior sagittal approach  for resection of the tumor in the lower and middle rectum. Clincal examination and history, per-rectal examination and transrectal ultrasound: to all patients to evaluate the size of the tumor and depth of invasion. Results: Straining during the act in 17 (81.6%) patients, incomplete defecation in 11 (52.8%) patients and bleeding in 12 (57%)  patients. Per-rectal examination: the mass was felt at the level from 6 to 7 cm with mean distance from the anal verge 6.4cm. There were no post operative complications in the form of anastomatic fistula, wound infection and anastomotic stenosis. There was no postoperative mortality. Continence function: excellent control of solid, liquid stool and flatus. 8 patients(38.4%) had 7-10 bowel movements per day whereas the others had only 3 to 4 movements daily, subsequently the frequency of bowel movements became normal in all patients within 3 months with 1 to 3 bowel movements per day. Conclusion:  Posterior sagittal approach had good exposure of the rectum and facilitated the mobilization of the rectum and resection without traction prolapsed through the anus as occuring in intersphincteric resection and gave good space for perfect anastmosis