A study of 120 patients undergoing elective colorectal operations has investigated the effect of adding oral neomycin and metronidazole to bowel preparation in a double-blind randomized controlled trial. Comparisons have also been made between a standard mechanical preparation and the use of an elemental diet. The addition of neomycin and metronidazole to bowel preparation significantly reduced the rate of wound sepsis (P less than 0.01), septicaemia (P less than 0.02) and anastomotic dehiscence (P less than 0.02); anaerobic infections were abolished and there was a significant reduction in the incidence of aerobic Gram-negative infections. Elemental diets were shown to have no advantage over mechanical preparation.
Twelve consecutive patients have been treated by rectal excision and endo-anal anastomosis since March 1978. Eight operations were for invasive carcinoma; extension into perirectal fat was recorded in all except one patient and early recurrence was observed in 3(6, 9 and 14 months after operation). Two operations were for carcinoma complicating extensive villous adenoma and 2 further patients underwent the procedure for excision of a Crohn's stricture. In the first 6 months after operation, stricture of the "neorectum' was observed in 7 of 8 patients and was associated with urgency of defecation in 6. Manometric studies indicated that although normal sphincter pressures were maintained, the capacity of the "neorectum' was significantly reduced at 6 months compared with preoperative values (P < 0.01). At 12 months only 3 of 6 patients still had a stricture, with urgency in 2. Complete continence was reported in all except one patient.
suMMARY Sixty-three patients with complete rectal prolapse and/or faecal incontinence have undergone anal manometry and the results have been compared with an equal number of age-and sex-matched controls. Maximal basal pressure (MBP) and maximum squeeze pressure (MSP) were measured before and at four months and a year after treatment. The anal pressures of normal subjects are presented. Patients with rectal prolapse alone had normal anal pressures, whereas patients with incontinence with or without prolapse had significantly lower basal and squeeze pressures than controls. Successful surgical treatment of prolapse or incontinence did not produce significant change in anal canal pressures, whereas the combination of pelvic floor exercises and a continence aid was associated with a significant rise in MSP.
Fifty-six patients were treated for rectal prolapse or incontinence. Rectal prolapse was present in 32 patients and was associated with fecal incontinence in 24 (75 per cent). Incontinence without prolapse was present in 24 patients, 12 of whom were less than 40 years old. Rectopexy was used for treatment of rectal prolapse. Surgical treatment of fecal incontinence was by postanal repair; external sphincter reconstruction and surgery was advised only if control of diarrhea and electrical therapy had been of no benefit. Rectopexy was completely successful at controlling rectal prolapse in all cases, and only four of the 20 (20 per cent) patients with incontinence and prolapse remained incontinent after rectopexy alone. Incontinence was completely controlled by postanal repair in 58 per cent of patients and by external sphincter repair alone or in combination with postanal repair in 67 per cent. Using a combination of therapies 45 of 48 patients who were initially incontinent were improved (94 per cent), and 42 of the patients have complete control of defecation (87 per cent).
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