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faradism, however, have not shown any objective improvement in performance.Subsequent operations for incontinence are difficult to evaluate in this series because of the small numbers involved. A few patients make an early and urgent demand for operation, while others are relieved to be rid of their prolapse, are quite happy to wear a pad to control incontinence, and do not wish to have another operation. Certainly in the present series we have not pressed additional operations on these patients, mainly because we are uncertain of success. The Thiersch operation is useful but it has a number of problems associated with it, viz., faecal impaction, and as many of these patients are constipated, this can present a serious problem. When wire is used it may fracture or cause ulcers. Nylon thread has proved to be more satisfactory.The most useful operation is the post-anal intersphincteric nylon-floss operation repair described by Parks (1967). Nevertheless, this is not an easy undertaking and there is often delay in wound healing. It is not advocated for minor degrees of incontinence or leakage.It is also clear, from our experience of I case, that colostomy is not necessarily the answer to incontinence.Lastly, there are a number of patients who might well be benefited by operations for their incontinence. The majority of these patients has declined the operation when the offer has been made, being content to be free of their prolapse. In a small number a further operation was inadvisable as their general health was poor. SUMMARYExperience of using Ivalon-sponge implants in IOI patients with complete rectal prolapse at St. Mark's Hospital is reviewed. It is a straightforward operation with minimal complications producing long-term control of the prolapse in 97 per cent of cases.Of those patients who had been incontinent, satisfactory restoration of continence was achieved in 70 per cent of cases for solid faeces and in 33 per cent for fluid faeces.Ivalon sponge is a foreign material that only produces moderate fibrosis in the tissues. It persists for at least 6 years in humans.COMPLETE rectal prolapse is a very disabling but non-lethal condition. Many operations have been devised to cure it but none has been entirely satisfactory. At the present time the Ivalon-sponge implant is being increasingly used throughout Great Britain. This paper reports our experiences using this operation during the years 1960-70. MATERIALSOne hundred and one patients underwent repair of complete rectal prolapse using an Ivalon-sponge implant (Fig. I). The youngest was ZI years and the oldest 82 years. Thirty patients had had previous surgery for the prolapse, including 14 Thiersch wire or nylon operations, 6 rectosigmoidectomies, 4Thiersch operations and rectosigmoidectomies, and 6 miscellaneous perineal repair procedures METHODSThe technique described by Wells (1959) using a 3-mm.-thick piece of polyvinyl alcohol (Ivalon) sponge placed behind the rectum was used. The sponge was perforated and soaked in saline before insertion. It was then ...

T h e results in patients with middle-third rectal cancers treated by restorative resection have been predicted by careful examination o f 546 abdominoperineal excision specimens, for tumour that might have been left behind if the more limited resection had been performed. I t was found that in the patient w h o had such tumours the survizal rate was very poor. I t is, therefore, concluded that restorative resection for middle-third rectal cancers, when technically possible, is justified on pathological grounds.

A prospective, randomized, single-blind, controlled clinical trial was undertaken to determine whether two doses of systemic Timentin provided superior prophylaxis against postoperative sepsis in elective colorectal surgery compared with a single dose of the same antibiotic. Timentin, a combination of ticarcillin and clavulanic acid was administered intravenously (3.1 g) at the commencement of operation to all patients, and this was repeated after 2 hours in those patients randomized to receive a second dose. The wound infection rate was 11 percent in the 143 patients completing follow-up and receiving a single dose, and 13 percent in the 128 patients receiving two doses of Timentin (P greater than 0.05). The rates of postoperative septicemia 3 vs. 4 percent and intra-abdominal abscess 5 vs. 8 percent were similar. Multivariate analysis of the factors likely to affect postoperative would infection rate demonstrated an association with the type of hospital, public or private, wound infection rate 16 and 6 percent, respectively (P less than 0.01), and the surgeon group defined by the number of patients contributed greater than 25 or less than 25, wound infection rate 6 and 18 percent, respectively (P less than 0.05). We concluded that a single dose of intravenous Timentin was as effective as two doses for prophylaxis against surgical infection and that the surgeon group and the hospital in which the operation took place were statistically significant predictors of postoperative wound infection.

PENFOLD : UNCOMPLICATED DIVERTICULAR DISEASE 695 (1964) technique of using a sleeve of sigmoid colon to line the totally denuded rectal wall has been used on three occasions and good faecal control has resulted in each case. Diathermy treatment of villous tumours has a high recurrence rate and makes subsequent local excision very difficult. Diathermy coagulation should be restricted to local recurrences.Acknowledgements.-We wish to thank Mr. N.