This study intends to make the transsphincteric approach to the rectum more well known, mainly because of the increasing number of small carcinomas and adenomas being detected by endoscopy following screening for occult blood. Thirty patients had rectotomy from 1983 to 1987. Curative surgery was performed on 15, whereas adenomas were excised in 11. Other indications were palliative excision, rectovaginal fistula, and postsurgical bleeding. Two patients had had previous transversostomies and a covering colostomy was done in one. Complications included wound infection in four and rectal fistula in four. Transversostomy became necessary in three. All colostomies were closed later and the mortality was zero. All preserved anal continence for solid and fluid feces, whereas three suffered from flatulence during a follow-up period from one to 46 months. The approach allows surgery in the upper part of the lower third of the rectum and the midrectum with a low mortality and complication rate, and should be preferred over major surgery in selected patients.