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Posterior iliac osteotomy is a recognised method employed to facilitate and support anterior abdominal wall closure in patients with bladder exstrophy, but it adds considerably to the already lengthy procedure of bladder exstrophy surgery. Anterior pelvic osteotomy of the superior ramus of the pubic bone was developed to overcome this problem and to achieve a stable anterior pelvic ring with tension-free soft tissue closure. It can easily be performed after completing the bladder closure, without the need to turn the patient.

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these, 91 patients, with 98 herniae, were available for follow-up. Only I case of recurrence following operation by this route was discovered.A method of operation using a retropubic exposure through a transverse abdominal incision is described. I t is not thought necessary to do a formal repair of the femoral ring except where it has been unduly enlarged.Of 67 cases where a formal repair of the ring had been performed, 9 (13 per cent) developed inguinal herniae on the same side. I n a small number of cases (31)) where the sac had been widely excised but no repair performed, there was only I case where an inguinal hernia had developed on the operated side.Some reasons are put forward in favour of a congenital origin for femoral herniae. CONCLUSIONST h e retropubic approach provides good access for dealing with femoral herniae and has marked advantages in bilateral cases and where bowel resection is necessary.If the sac is widely excised and the investing fascia repaired, the recurrence rate is minimal. But in cases where the femoral ring has been widely enlarged it should be reduced in size with unabsorbable sutures.

In a large series of lipolysis procedures, followed for 2 years, there have been no serious major and few minor complications. Selection of patients is important and for the best results patients should be under 30 years of age. Many areas of lipodystrophy may be dealt with at one session in most cases. However, postoperative circulatory control, especially during the first 24 hours, is very important and always requires vigilance to avoid the tendency to hypotension. Early local problems include tenderness, bruising, and swelling, and the management of these is discussed. Later complications include skin flaccidity, dimpling, and localized areas of pigmentation and hypesthesia. The prevention and management of all these sequelae and others are discussed.

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MEDIBALu1 I feel strongly that those in medical charge of boys' schools should be cognizant of this total situation, and should, in the rare intractable case, even suggest to the boy and his parents that future plans for a service career should be revised. Obversely, it should go without saying that, whether or not the removal of many a distinguished general's vest would reveal many an acne scar, one is entitled now to expect uniformity of action on this problem from all the relevant Service medical boards.-I am, etc.,