The Shouldice technique for inguinal hernia repair has been suggested by some authors as the best conventional method against which other methods using prostheses should be compared. The paper which follows is a systematic review involving a comprehensive search of the medical literature to identify all clinical trials (article or abstract) evaluating the Shouldice repair. After assessment of certain quality criteria, the best studies were pooled in a meta-analysis. Nine publications were found with 11 study arms. In ten studies the results of the Shouldice technique were better than the results of the control arm. Six studies could be pooled in a meta-analysis of 2500 patients; Shouldice was significantly better than control methods (relative risk 0.62 (95 per cent confidence interval 0.45-0.85)). In spite of possible bias caused by different variables (modifications in operative technique, suture material, level of surgeon, follow-up methods and outcome measurement), the results of this systematic review suggest that the Shouldice method is the best current conventional technique for inguinal hernia repair.

Fifty-one of 256 patients underwent a palliative procedure for advanced carcinoma of the stomach (TNM stage IV). The resection was classified as palliative if metastatic disease was left behind in the lymph nodes, if involvement of organs elsewhere in the abdominal cavity was present, or if microscopy revealed tumor tissue in the resection lines. Twenty-six patients underwent a resection for palliation. There were 14 total and 12 partial gastrectomies. There were 2 deaths after total gastrectomy because of anastomotic leakage. The mean survival time after operation was 9.5 months. In 13 patients (50%) palliation was good with preoperative symptomatic relief without initiating new symptoms, acceptable body weight, and solid food intake. In 7 patients (27%) palliation was moderate, and in 4 (15%) poor. The results after gastroenterostomy in 25 patients were poor. The study shows that palliative total and partial gastrectomy can produce palliation in advanced gastric cancer.

The Hartmann procedure During a 10-year period, 59 patients had a Hartmann operation f o r diverticular disease ( n = 19), carcinoma ( n = 21), anastomotic disruption ( n = 5 ) , injury ( n = 3 ) and various other conditions ( n = I I ) . Twenty-two patients (37.3 per cent) died postoperatively.Wound infection or wound dehiscence occurred in 24 patients. Other complications inherent in this operation were colostomy necrosis or retraction ( n = 12) and leakage of the rectal stump (n = 3 ) . The mean hospital stay of the surviving patients was 28.4 days. Colorectal continuity was subsequently restored in 12 patients (32.4 per cent) and no difJulties were encountered with this procedure.

Mortality was high among those aged over 80 with acute abdominal complaints who were admitted through the emergency department, particularly among those who were operated on and those who were misdiagnosed. Guidelines for an earlier and more comprehensive diagnostic approach could lead to better insight into the prognosis and thereby to more adequate and better-targeted treatment.

Summary. We report the relative frequencies of members of the Bacteroides fragilis group in the faeces, in colon lavage fluid obtained pre-operatively, and in colonic tissue specimens obtained at operation from 10 patients with colonic cancer. B. vulgatus was the most and B. fragilis and B. ovatus were the least frequently isolated Bacteroides spp. in the faeces of the 10 subjects. B. uniformis and B. thetaiotaomicron ranked second and third in the faeces. The relative frequencies of all species except B. fragilis were lower in the lavage fluid and in cultures of mucosa. The relative frequency of B. fragilis increased from 4% in faeces to 39% in the final lavage fluid and to 42% in the colonic mucosa culture. Our results suggest that B. fragilis has a more intimate association with the gut mucosa than other members of the B. fragilis group, which might be one explanation for the high incidence of this species in gutassociated intra-abdominal infections.