David Failes

Irradiation injuries of the large intestine

A series of 15 patients suffering from irradiation injuries to the large bowel is reviewed. Ten patients required surgical intervention, initially a diverting stoma in eight; intestinal continuity was re-established in three patients. Loop ileostomy may be preferable to loop tranverse colostomy for fecal diversion, as the former is easier for the patient to manage, and ensures that there is no interference with blood supply to the colon should an abdomino-anal pull-through procedure be indicated later to restore continuity. As only three of the patients developed recurrent carcinoma, the initial operation for irradiation injury to the large bowel should be carefully planned so that the patient is not ultimately cured of carcinoma but left with a permanent stoma.

Pilonidal sinuses of the anal canal: Report of a case

SummaryThe many reported cases of pilonidal sinuses arising outside the sacral area have been collected, and reference is made to nine unreported cases seen in the practices of the other 15 surgeons at Sydney Hospital. It is concluded that such pilonidal sinuses are not rare. In addition to these cases, a case is presented as an example of a pilonidal sinus arising in the anus and anal canal.

Squamous-cell carcinoma of the anus

SummarySeventy-six cases of squamous-cell carcinoma of the anus are reviewed—11 of these were classified as anal-margin tumors and 65 as anal-canal carcinomas. Fifty-nine of these were available for five-year follow-up, ten having been treated within the last five years, and seven were lost to follow-up. The five-year survival rate for nine patients with neoplasms arising at the anal margin was 67 per cent (six survivors) and for 50 patients with anal-canal neoplasms, 32 per cent (16 survivors). Radiotherapy proved unsatisfactory, and radical excision was the only method of treatment which carried reasonable prospects of cure.

Prophylactic administration of low-dose heparin in colorectal surgery.

SummaryA retrospective study of 192 patients operated on by three members of the Edward Wilson Colon and Rectum Unit, Sydney Hospital, was carried out. All operations performed involved dissection within the pelvis. Prophylactic administration of low-dose heparin was used for 71 of these patients. The incidences of clinical thromboembolic disease were 7 per cent in both the group receiving heparin and the other group. In slightly more than half of the patients, pulmonary emboli occurred in the absence of peripheral deep venous thrombosis. It is suggested that the source of these emboli was thrombosis arising in the pelvic veins.

Cancer of the colon and rectum: Operative management of rectal carcinoma

Mr. Chairman, ladies and gentlemen, in the operative management of carcinoma of t.he rectum, ,the surgeon has a wide variety of operations from which to choose~ T h e aim of this paper has been simply to analyze the various operative procedures carried out, and to evaluate some of the factors influencing the choice of procedure. This paper presents a retrospective review of 209 patients, most of whom were treated at Sydney Hospital (luring the past ten years (Fig. 1). Of this total of 209 patients, 144 underwent treatment designed to cure. The remaining 65 were treated by palliative means only. In 16 patients no resection was done; nine were considered unsuitable for any operation, and seven underwent colostomy only for the relief of obstruction. Thus, of 209 patients in this review, 193 underwent some type of resection, giving an excisability rate of 92 per cent. The selection of the most suitable operation requires very careful preoperative assessment and depends on a number of factors. Some of those [actors concern the patient, his general condition, age, sex, and build, while others relate to the type of tumor. In this regard, palpation of the tumor and sigmoidoscopy under anesthesia are most helpful, enabling a much more accurate assessment of the level of the growth, its size, extent and mobility. Biopsy of the lesion is thus facilitated and