Sixty-six patients requiring catheterization in the course of general surgical operations were randomly allocated into two groups. Of the 34 patients catheterized urethrally 16 developed urinary tract infections whereas of the 32 suprapubically catheterized patients only 2 developed an infection (P less than 0.001). Five patients required recatheterization after removal of their urethral catheters. There were no major complications associated with the use of suprapubic catheters. We propose that, when catheterization is required during a general surgical procedure, the suprapubic route is to be preferred.
The syndrome of acute colonic pseudo-obstruction is well delineated but its aetiology remains poorly understood and patients are still treated inappropriately. This article reviews the pathogenesis and surgical management of this condition. Early diagnosis is stressed as a pivotal factor in reducing morbidity and mortality.
A prospective study was made of 92 patients who underwent emergency colorectal surgery during a 1-year period. A dedicated emergency theatre allowed half of the patients to be operated on between 09.00 and 17.00 hours with greater seniority of operating surgeons. The overall mortality rate was 14 per cent and the primary resection rate was 79 per cent. The mortality rate was 12 per cent for right-sided resection with anastomosis and 24 per cent for left-sided resection without anastomosis, including those undergoing Hartmann's procedure which had a 35 per cent mortality rate. Immediate left-sided anastomosis was performed safely in all 14 patients in whom it was attempted. Firms headed by consultants with and without a special interest in colorectal disease made differing use of primary resection and immediate anastomosis (67 versus 41 per cent, P less than 0.05) and Hartmann's (7 versus 25 per cent, P less than 0.05) and non-resectional (15 versus 29 per cent, P not significant) procedures. Retrospective surveys of perioperative deaths examine inadequate management and subsequent mortality rates, but do not reveal the significant morbidity rate that occurs in survivors. This audit revealed significant differences in the management of patients with colorectal emergencies between firms headed by specialist and non-specialist consultants. In order to minimize these differences we believe that recent advances in colorectal practice should be included in the training of all surgeons.
One hundred and fifteen patients who were treated by a proctocolectomy in Oxford between 1972 and 1984 for inflammatory bowel disease have been studied. All the patients had the rectum removed by the technique of perimuscular dissection which was introduced in 1972 in an attempt to overcome the problems associated with the previous types of proctectomy. The method has been shown to be safe; the operative mortality was 1.7 per cent. The most worrying potential complications due to permanent autonomic nerve damage (i.e. impotence and urinary incontinence), which previously have been recorded as occurring in a significant percentage of patients, were completely prevented by the method of dissection. One man suffered transient impotence which responded to psychiatric treatment. There were no long term urinary tract or sexual problems. Postoperative complications occurred in 37 per cent of patients, perineal wound infections being the most common (25.7 per cent). Perineal healing, however, was achieved in 75 per cent of patients by the time of their discharge from hospital. The mean length of postoperative hospital stay was 19 days in patients with ulcerative colitis and 15 days in patients with Crohn's disease. Our rate of perineal healing is better than has been recorded using other operative techniques.
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