Only after the levators are approximated should the prolapsed bowel be prepared for amputation. It is essential that the normal anatomic position of the bowel be retained. For this reason it has been found judicious to split the anterior as well as the posterior wall of the prolapsed large intestine almost up to the region where the bowel will be divided. This should be done carefully so that sufficient bowel is available for approximation to the pectinate line, yet a sufficient amount is removed to prevent recurrence (Figure 18). After the bowel has been divided, the surgeon should insert a finger into the lumen of the bowel to again check snugness of the approximation of the levator muscles. Enough room should be available to admit the index and middle fingers easily. If the approximation of the levators seems to be too snug and the blood supply to the bowel compromised, one of the sutures may be removed, or, if too large, an additional approximation of the levators should be considered.