ObjectiveTo review the historical and current practices of the pull-through procedure for middle and lower rectal cancers.MethodsAnalysis of the outcome and evaluation of physiologic function of Parks' coloanal anastomosis, the Bacon pull-through, and the Cutait operation.DiscussionBefore the advent of the circular stapler, the pull-through procedure was practiced primarily for reconstruction of inaccessible lesions in the lower pelvis. Compared with the other procedures for removal of the rectum, the operation has been proven to be equally as effective for cancer cure and postoperative morbidity. The functional results vary according to the technique employed. Physiologic data from the Bacon pull-through operation indicate that because of the loss of the reservoir function and the failure of reflex inhibition of the internal sphincter, the patients have to initiate the act of defecation with an enema. Conclusion: The pull-through procedure is a valuable sphincter-saving operation. With several chemoradiation protocols currently active, it is projected that the procedure will see a resurgence.