Background: The local recurrence rate after potentially curative resection for rectal carcinoma has remained relatively 
high with little change in the prognosis of this common disease. Many attempts had been made to decrease the local 
recurrence rates after anterior resection of the rectum, the most important of which has been total mesorectal excision. The only drawback of this technique has been its association with a high anastomotic leakage rate. 
Patients and methods: Thirty six patients with lower and middle third rectal carcinoma have been operated upon by low anterior resection with total mesorectal excision between January 1996 and December 1999. We used the descending colon near the splenic flexure for the anastomosis with the anal canal, making sure to fill the pelvic cavity -that resulted from mesorectal excision- with the redundant colon behind the anastomosis, to prevent any pelvic collection and hematoma formation. A defuncioning transverse loop colostomy was performed in 29 patients. The patients were followed up as regards anastomotic leakage rate, local recurrence and functional outcome. Follow up ranged between 7 - 48 months with median of 38 months. 
Results: Anastomotic leakage occurred in 3 patients (8.3%), two of whom did not have a defunctioning colostomy 
Local recurrence rate was 6.6%. Functional outcome was grade I continence in 65.5% and grade II in 25% ofpatients. 
Conclusion: Total mesorectal excision accomplishes a very low local recurrence rate, the claimed high leakage rate 
could be ameliorated by mobilizing the colon up to the hepatic fiexure, using the descending colon near the splenic flexure for the anastomosis which is done without tension, permitting the redundant colon and the omentum to lie in the sacral hollow behind the anastomosis to prevent hematoma formation and performing a defunctioning colostomy.