One hundred and twenty-three patients (M:F, 0.9:1; mean age 62 years) underwent 156 operations between 1954 and 1984 for correction of late colostomy complications (stenosis 65 patients, prolapse 16 patients, paracolostomy hernia 42 patients). Sixty-three per cent of patients eventually had a good result but in some up to 5 operations were necessary. Local excision of scar tissue at the mucocutaneous junction was associated with a 61 per cent (43/71) success rate for relief of colostomy stenosis. Where local fixation failed to prevent recurrent colostomy prolapse (13/20, 65 per cent of local fixation operations), colectomy and ileostomy was the most effective second procedure (2/3, 67 per cent success rate). Where local repair of a paracolostomy hernia failed (15/32, 47 per cent of local operations), resiting of the stoma to the umbilicus or right side of the abdomen produced better results (3/7, 43 per cent success rate) than resiting to another trephine on the left side of the abdomen (2/14, 14 per cent success rate).
Disruption of the anal sphincter results from obstetric injury, ano-rectal operations or external trauma. Obstetric or surgical division of the sphincteric mechanism may not be immediately apparent and the clinical presentation of incontinence may occur several years later [1, 2]. Reconstruction of the sphincter using a fascial sling or direct end-to-end repair of the disrupted sphincter result in a high failure rate. Failure after direct end-to-end repair is usually caused by break down of the suture line owing to retraction of the muscle ends [3]. Parks advocated an overlapping repair [4] in which the disrupted ends of the sphincter were mobilised and wrapped around each other. This paper reports the results of overlapping sphincter repair for faecal incontinence resulting from trauma, after a 5 year follow-up period.
A review of the St Mark's Hospital Polyposis Registry has revealed an association between adenomatous polyposis (familial polyposis coli) and thyroid carcinoma. Even though full clinical information was unavailable on all patients in the registry, it is evident that young women (below 35 years of age) are at particular risk of developing thyroid cancer, mainly of a papillary type, their chances of being affected being approximately 160 times that of normal individuals. All patients with adenomatous polyposis should thus have regular thyroid examination.
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