Howard D. Trimpi

The magnetic stoma device: A continent colostomy

The magnetic ring device implanted in an attempt at achieving continence in the colonic stoma, consists of a subcutaneous ring and a removable magnetic cap with a charcoal filter. Fourteen patients were selected from a potential number of 58 candidates. Fifty per cent of the patients have had good results. No complications were attributable to the implanted device. There was no incidence of parastomal hernia.

Proctologic disorders and hematologic diseases

SummaryWe have discussed our experiences with 11 patients who had colorectal disorders and hematologic diseases. Most (9 of 11) had anorectal problems which fell into the categories of local infection, sepsis, and bleeding. Six of the nine patients with anorectal disorders had had anorectal disease previously, before recognition of their hematologic disease. Methods of treatment and general care of patients with concurrent proctologic and hematologic disorders are discussed. Chemotherapy, platelet transfusions, and other supportive measures are used in the effective treatment of the anorectal disorders.

Low end-to-side rectoenteric anastomosis with single-layer wire

SummaryA study of 41 cases where a single layer of 5-0 monofilament stainless steel wire is used for low end-to-side rectosigmoid or ileorectal anastomosis has shown satisfactory results. The procedure should be considered particularly where there is gross disparity between the sizes of the approximated cut ends.

von Recklinghausen’s disease with involvement of the rectum report of a case

SummaryA case of systemic neurofibromatosis involving the rectum and the anal canal is presented. The literature is reviewed and it is stressed that the neurofibromas should be considered in the differential diagnosis of gastrointestinal bleeding when cutaneous nodules are discovered.

Hyaluronidase in local anesthesia for severe hermorrhoids and procidentia

SummaryThe value of local anesthesia wida hyaluronidase in operations on the anal canal and lower rectum is pointed out, and particular emphasis is made of its effect upon hemorrhoidal edema. The relative safety of this type of locaI anesthesia for more formidable operative procedures such as perineal resection and repair of levator musculature for rectal procidentia is discussed. Muscle relaxation is excellent, even though direct infiltration into the anal sphincters and levator ani muscles is not needed. The instantaneous action of the anesthetic agent is striking.We believe that the two patients with procidentia would not have done well under general anesthesia. Local anesthesia made possible the successful correction of debilitating rectal prolapses.

Transverse incision in abdominal surgery of the colon and rectum

Summary and ConclusionsAdvantages of the transverse abdominal incision when employed in surgical procedures for lesions of the rectum and colon are: Excellent exposure; Diminished depth of the wound and easy access to the entire pelvis; Less postoperative discomfort; A stronger wound and lower incidence of dehiscence, evisceration and incisional herniation. Retention sutures, tight taping and abdominal binders are not required. Early ambulation and deep breathing are facilitated. There is a shorter period of convalescence and rehabilitation is possible earlier. The final result is a strong, narrow scar which is least displeasing cosmetically.

Is reperitonealization necessary

RESECTIONS Of the rectum or colon are not always accompanied by repair of denuded parietal peri toneum. In a personal series of 322 resections in a 10-year period, in which small and large areas of parietal per i toneum were excised, postoperative adhesions were not encountered. T h e causes of adhesions that required surgical procedures were slight leakage from an anastomosis, the presence of a foreign body, or sanguineous fluid in pelves that had not been drained adequately. At one time it was believed that all denuded areas should be repaired and many ingenious methods were devised for covering them. Robbins and associates 1 refuted this concept in a paper read before the American Surgical Association in St. Louis in 1949. In discussion, Wangensteen stated that healing of an anastomosis would be impaired if not surrounded by peri toneum, and he described a method of Utilizing, for this purpose, the mesentery of the terminal port ion of the ileum. Stone agreed with Brunschwig that patients who undergo operation after denudation of parietal per i toneum in the flank areas of the abdomen present no problem as far as adhesions are concerned, but he seriously questioned the advisability of leaving visceral per i toneum unrepaired. Rhoads described regeneration of the peritoneum in rats, where he found that the parietal per i toneum regenerates more quickly without suturing, and that sutures could cause adhesions. As a remi t of these discussions, the author