Samuel B. Labow

Transanal rectovaginal fistula repair

In this update, 15 additional successful transanal repairs followed for one to six years postoperatively for low rectovaginal fistulas without colostomies are added to the uniformly successful 20 patients presented in a 1978 report. Changes in perioperative routines have greatly enhanced cost efficiency and these modifications are enumerated. The repair still encompasses total excision of the epithelialized fistula, and reapproximation of the attenuated septal fibers and anal sphincter mechanism, as well as the caudad rectal mucosal advancement that covers and protects the repair from the fecal stream and the high intraluminal pressures of defecation. Once again, we have excluded inflammatory, neoplastic, and irradiation-caused fistulas from this discussion, although we, as well as others, have applied this technique in selected cases.

Anastomotic recurrences after low anterior resection

A retrospective study was done comparing the rates of local recurrence in cancer of the rectum treated by low anterior resection using the stapling device or hand-sewn. It was found that there was no increase in recurrences when the stapler was used, even though lower lesions were treated.

The Hartmann procedure in the treatment of diverticular disease

SummaryThe Hartmann procedure would appear to offer many advantages and few disadvantages in treating those cases of sigmoid diverticulitis complicated by obstruction or pelvic or intraperitoneal abscesses, with or without perforation and diffuse peritonitis.

Colonic adenocarcinomas in patients with ureterosigmoidostomies

SummaryTwo additional cases of adenocarcinoma of the sigmoid colon occurring at the site of uretero-sigmoidostomy are reported. The high risk of this complication occurring in patients who have under-gone ureterosigmoidostomy is described. The possible shortness of the interval from diversion to development of an adenocarcinoma, especially in those cases involving carcinoma of the bladder, is emphasized. It is strongly recommended that careful follow up of such patients should begin within several years of establishment of the ureterosigmoidostomy.

Suture-line recurrence in carcinoma of the colon and rectum.

SummarySeventy-three patients with adenocarcinoma of the sigmoid, rectosigmoid and rectum were reviewed to determine the incidence of suture-line recurrence. Four patients (5.5 per cent) developed sutureline recurrences despite the use of a number of techniques to reduce this problem. All four recurrences were in patients who had Dukes’ C lesions of the rectum. It would appear that such recurrences are not related to implantation factors alone.

The EEA stapler in low colorectal anastomoses

The initial experience of several colonic and rectal surgeons with the EEA stapling device for low colorectal anastomoses is reviewed. It was found that the EEA gives a better anastomosis than is possible by hand and that a surgeon familiar with doing a low anterior resection can perform it on patients for whom it is not possible by hand. However, the results with the EEA are not perfect or guaranteed. The many complications associated with its use are reviewed, and ways to avoid them are discussed.

Glucagon, a useful adjunct in anastomosis with a stapling device

Spasm of the proximal sigmoid colon has been a major hindrance in the use of the EEA stapler in low anterior resections. Intravenous glucagon, by causing rapid relaxation and hypotonicity of the sigmoid colon, appears to help correct this problem and allows for a safer and more atraumatic anastomosis.

Presacral myelolipoma: Report of a case and review of the literature

SummaryA benign presacral tumor composed of adipose and hematopoietic tissue was found in an asymptomatic 47-year-old woman. Due to the patients associated medical conditions the tumor was diagnosed by transanal biopsy and was not removed. Only three similar cases have been reported.

Modification of silastic sling repair for rectal procidentia and anal incontinence

Des bandes de feutre sont ajoutees au «silastic» pour augmenter sa reactivite et son adherence aux tissus

Electrosurgery: Principles and use.

SummaryElectrosurgery is a useful tool. Some basic knowledge of the terms, waveforms and circuits allows more intelligent use. Let us all use the same terms so that we may understand the work of others and share our experiences. Learn about your own particular apparatus and its capability. Practice on a piece of meat if necessary. Be aware of the potential complications reported in the literature, and how they may be prevented.