This year, it is 125 years ago that the Viennese surgeon J. v. Hochenegg (Fig.
1) published the first case of a successful rectal resection with preservation of the anal sphincter in Wiener klinische Wochenschrift [
1]. Since the first rectal resection by Lisfranc in 1826, tumours of the rectum were removed by the perineal route to avoid a laparotomy. The final result was a perineal colostomy. This was very difficult to manage for the patients. With the introduction of the sacral approach by Kraske, a better access to the rectum was possible. This technique was used mainly in Germany and Austria [
2]. It allowed a resection of tumours, even of the rectum’s upper part. Hochenegg realized that it was not necessary to sacrifice the sphincter in cases where the tumour was located in sufficient distance from the anus. The first case was a young woman aged 32 years. Her tumour was located 7 cm above the anus. The bowel preparation was performed with castor oil. The operation was conducted under chloroform anaesthesia and in lateral position. The rectum was exposed from a sacral approach after removal of the lower part of the sacrum and the os coccygis. After complete mobilization, the tumour was resected and end-to-end anastomosis between the sigmoid and the rectal stump was performed. …
