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Anhand von 500 konsekutiven Colonanastomosen werden verschiedene Operationsmethoden beleuchtet. Spannungsfreiheit und gute Vaseularitat sind die wichtigsten Voraussetzungen fur den Erfolg. Auser bei der sehr tiefen Anterior resection, wo Seit-zu-End-Anastomosen zur Anwendung kommen, befurworten wir die End-zu-End-Anastomose mit allschichtiger, einreihiger, auf Stos adaptierender Naht. Bei allen septischen Komplikationen (perforierte Diverticulitis und perforierte Carcinome) steht die Entfernung des septischen Herdes im Vordergrund. Mortalitat der Klinik: Palliativ- und Notfalleingriffe 11%, 393 palliative und kurative Wahloperationen 7,6%; 72 eigene konsekutive Wahloperationen und 20 konsekutive Primarresektionen bei perforierten Colonaffektionen waren von 3 Fatalitaten gefolgt, von denen keine durch lokale Komplikationen bedingt war.

Giant sigmoid diverticula, although uncommon, may be diagnosed preoperatively. This condition should be suspected in an elderly patient presenting with abdominal pain and a palpable lower abdominal mass. A plain film of the abdomen showing an air-filled cystic structure in the region of the abdominal mass is strong evidence in support of this diagnosis. Barium enema examination, if performed, will likely show associated diverticular disease and in some instances may outline a communication between the bowel lumen and the diverticulum. If signs of peritoneal irritation are present, perforation or torsion of the diverticulum with infarction is likely. Recommended treatment is resection of the diverticulum with the adjacent bowel and end to end anastomosis of the uninvolved colon. When perforation has occurred and adjacent tissue is contaminated with bowel contents or when active inflammation is present, a two stage procedure is advantageous.

To make an accurate comparison between ileal and colonic conduits, an ileal conduit was created from one kidney and a nonrefluxing colonic conduit from the other kidney in 16 adult mongrel dogs. The major variable between the two was the presence or absence of reflux. The dogs were studied by excretory urography, conduitograms, pressure studies, and urinary cultures. All dogs were sacrificed at 3 months, and urine cultures were collected at necropsy from conduits and both renal pelves. In each of five control experiments, one kidney was connected to either an ileal or a colonic conduit while the other kidney remained in continuity with the bladder. Although most dogs had significant bacterial growth in both conduit and ureteral urine, histologic sections revealed pyelonephritis in 83% of 12 kidneys connected to ileal conduits as compared to 7% of 14 kidneys connected to colonic conduits. All control kidneys were histologically normal. This study demonstrates that ureteral reflux from ileal conduits produces histologic evidence of pyelonephritis. Colonic conduits, by preventing reflux of infected urine, reduce the frequency of pyelonephritis and offer definite advantages for long-term urinary diversion.

THE treatment of ulcerative colitis is primarily medical. Experience has shown, however, that at least 25 per cent of patients with ulcerative colitis require surgical intervention,1 , 2 to preserv...

Of 27 patients with acute rectal hemorrhage studied by emergency selective arteriography, the bleeding point was demonstrated in 18. Fifteen of these were in the colon, and 13 were secondary to diverticulosis. Twelve of the offending diverticula were located to the right of the splenic flexure. Nine were in the ascending colon. Emergency arteriography was the only method that consistently demonstrated the bleeding point in these patients. The location of the majority of bleeding diverticula in the ascending colon weighs strongly against the use of emergency sigmoid colectomy in this group of patients.

The bowel must be well prepared. The anastomosis should not be jeopardized by use of too many sutures. The perineal floor is not closed; the anastomosis is left intraperitoneally where it can be protected by omentum or small bowel in the event of a separation. A tube cecostomy is a valuable adjunct in a difficult resection. Oral feedings should be allowed only after satisfactory restoration of bowel function. Bandages are removed permanently on the first postoperative day, and showers and baths are allowed as soon as the patient is sufficiently ambulatory. Colon surgery can be done effectively without the use of drains, prophylactic postoperative antibiotics, or prophylactic postoperative gastric suction.

Clinical experience with postoperative intraluminally administered antibiotics in 119 patients undergoing operations on the colon has been summarized. The reasons for this kind of therapy have been outlined, and the guiding principles of careful attention to basic surgical principles have been re-emphasized. There were no complications associated with the use of the tube in 111 patients, and only one significant tube complication in the entire series. There were no complications associated with the postoperative intraluminal administration of antibiotics in 102 patients, and the major complications of enterocolitis and fungus infections each occurred only once. The incidence of complications directly attributable to surgery of the colon has seemed to be decreased by the method of therapy described here. Postoperative intraluminal administration of antibiotics via a plastic tube following surgery of the colon is thought to be safe, effective and deserving of further evaluation.

Neomycin, neomycin-sulfathalidine, and kanamycin are popular intestinal antiseptics today, and all of them adequately suppress aerobic colonic microorganisms. However, anaerobic bacteria are being implicated in the development of wound complications after colon surgery, and none of the usual intestinal antiseptics effectively suppresses these organisms.

Complications of cardiac arrest and of arterial and venous thrombo-embolic disease have been discussed from the viewpoints of etiology, diagnosis, prevention and therapy.

Summary A method of simultaneous bilateral ureterocolic anastomosis based on that devised by Davalos is described, and a short account is given of four patients on whom it was employed satisfactorily.

1. 1. The complications arising from 226 cases of resection of the colon for various types of lesions have been reviewed. Only non-obstructive cases of primary anastomosis distal to the ascending colon are considered. 2. 2. The incidence and severity of complications attributable to leakage from the suture line or perforation of the large bowel were lower in the group of sixty-seven patients treated with complementary cecostomy. In contrast to the group in which no proximal stoma was established, conditions of anastomosis were such in most of the cases in which complementary cecostomy was performed that complications were to be expected. The difference between the two groups, therefore, appears to be significant. 3. 3. Complementary cecostomy is still a useful procedure and should be considered when ideal conditions for bowel anastomosis are not present.

An experience with urinary diversion by ileal bladder has been presented. Emphasis has been placed on its wide application to pelvic malignancy with extension of the disease to bladder base and ureters. This is applicable especially in men with rectal cancer where involvement of the prostate and posterior urethra make consideration of pelvic exenteration necessary. Early and late complications and the operative mortality rate have been studied in some detail. An attempt has been made to compare ileal bladder with other types of urinary diversion and to relate them to the treatment of locally advanced colorectal cancer.