The posterior (Kraske) approach to the surgical management of villous tumours of the rectum was used in 12 patients. One patient died in the postoperative period and in six others there were complications (wound infection in three, wound infection and rectal hemorrhage in one, wound dehiscence in one and cellulitis in one), but there was not a single fistula. This approach represents an easy and well-tolerated operation especially in older patients who are otherwise poor operative risks. The posterior approach is also excellent for excising lesions of the mid-rectum that may be too bulky for endoscopic removal and too proximal for their excision through the dilated anus. The procedure is not appropriate for malignant tumours and the benign nature of these tumours is best appreciated preoperatively by digital palpation; however, confirmation of their exact nature requires microscopic examination of the whole lesion.