Constipation and incontinence are frequent complications of rectal prolapse. Surgery should not only aim to correct prolapse but also improve bowel and sphincter function. From 1986-1991 42 patients with procidentia were treated by rectopexy and sigmoid resection. The mean age was 61.1 years. Thirty-nine patients were available for follow-up examination. Mean follow-up was 54 months. Functional data were collected prospectively before the operation and at follow-up and included clinical parameters, a constipation score, an incontinence score, anal manometry [mean resting pressure (MRP), mean maximum pressure (MMP)], proctography [anorectal angle (ARA)] and colonic transit studies [mean transit time (MTT), rectosigmoid transit time (RSTT)]. The postoperative complication rate was 7.1% (n = 3), mortality was 0%. No recurrence was seen. Constipation complaints improved from 43.6% to 25.6% (p < 0.001) and incontinence from 66.6% to 23.1% (p < 0.001). MRP increased from 36.5 mmHg to 46.0 mmHg and MMP from 90.5 mmHg to 103.0 mmHg (p < 0.001). ARA changed from 102 to 98 degrees (p < 0.001) and correlated with sphincter tone and continence. MTT decreased from 47.8 to 38.5 hours, segmental transit (RSTT) from 21.1 to 12.7 hours (p < 0.001). Our results indicate that rectopexy with sigmoid resection is a safe and effective procedure for rectal prolapse and improves functional disorders of bowel and sphincter.

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The flab method is a simple but especially practical technique for IORT in the pelvis. Adjuvant/neoadjuvant therapy combined with resection/IORT is associated with high morbidity but acceptable mortality. Preliminary survival data are encouraging and call for a controlled prospective randomized trial.

Present conventional surgical therapy of obstructive colon cancers of the right colon is primary resection, whereas in the left colon it is a two-stage or three-stage operation with a temporary colostomy. Morbidity and mortality rates in staged operations are still as high as 40% and 24%, respectively. Preoperative recanalization of obstructive cancers by neodymium-YAG laser vaporization will tend to relieve the symptoms of ileus and will permit preoperative peroral bowel lavage. For this reason primary resection with primary anastomosis is practicable in patients who have recovered from symptoms of ileus. In 27 cases who had been operated on with left-side hemicolectomy or anterior resection, the mortality rate was 3.7% (1/27). The total inpatient mortality rate of all laser-treated patients who had been operated on by different operative procedures, or who had not been surgically treated, was 8.8% (5/57).