An international working party with experience in the performance of an alternative haemorrhoid operation through the use of the circular stapler was convened for the purpose of developing a consensus as to the criteria for undertaking this procedure. The agenda consisted of first, naming the operation; second, the indications and contra-indications for its performance; and third, the preferred surgical technique. Among the recommendations for individuals who plan to embark on this surgery are that experience with anorectal surgery and an understanding of anorectal anatomy are requisites; experience with circular stapling devices is essential; and the surgeon must attend a formal course which should include lectures, videos, the application of the instrument in models, and observation of the operation as performed by a surgeon recognized by his or her peers-leading ultimately to undertaking the procedure while being observed by an experienced surgeon. Following satisfactory completion of the above, independent responsibility should be determined by an individual's department of surgery.

An international working party was convened in Rome, Italy on 16-17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.

Local excision of rectal cancer can be a part of treatment of this tumor. The authors do not feel that this procedure is only palliative. Clinical staging I and II, tumor diameter less than 3 cm, malignancy grade 1 or 2, invasion no deeper than the submucosa, and no signet-cell carcinoma are all requisites for limited, local excision of rectal carcinoma. Patients operated upon under these criteria have a five-year survival rate of 89.6 +/- 21.7 per cent for those with invasion into the submucosa and 78 +/- 49.9 per cent for those with invasion into the muscularis propria. But to get such good results, strict self control must be exercised in selecting patients.

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CARCINOMA OF RECTUM CHAPUIS ET ALll 12 GEHAN EA Ageneralised Wilcoxon Test for comparing arbitarily 13 PENFOLD JCB A comparison of restorative resection o f , single-censored samples 61ornetnka 1965 52 203-223 carcinoma of the middle third of the rectum with 18 abdominoperineal excision AuST NZ J SURG 1974, 14 MAYO CW FLY OA Analysis of five year survival In carcinoma of the rectum and rectosigmoid Surg Gynecol Obstet 1956 103 94-1 00 anterior resection for carcinoma of the rectum and rectosigmoid Surg Gynecol Obstet 1958, 106 695-698 16 DEDDISH MR STEARNS MW Anterior resection for Carcinoma of 21 the rectum and rectosigmoid area Ann Surg 1961, 154961-966 44 354-356 l9 15 MAYO CW LABERGE MY HARDY WM Five year survival after 20 SLANETZ, CA. HERTER FP, GRINNELL RS, Anterior resection versus abdominoperineal resection for cancer of the rectum and rectosigmoid. Am J Surg .1972; 123:llO-117. GLEN F, MCSHERRY CK. Carcinoma of the distal large bowel: 32-year-review of 1,026 cases. Ann Surg 1966; 163:838-849. NICHOLLS RJ, RITCHIE JK, WADSWORTH J, PARKS AG. Total excision or restorative resection for carcinoma of the middle third of the rectum. 6 r J Surg 1979; 66:625-627. PATEL S . TOVEE EB, LANGER B. Twenty-five years of experience with radical surgical treatment of carcinoma of the extraperitoneal rectum. Surgery 1977; 82:460-465. WHITTAKER M, GOLIGHER JC. The prognosis after surgical treatment for carcinoma of the rectum. 6 r J Surg 1976; 63:384-388.

coloproctology 2012 -Die Entwicklung geht weiterSehr geehrte Leserin, sehr geehrter Leser,

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Operative mortality after intestinal resection in 155 patients with Crohn's disease was 8.4%. In 12 of 13 the cause of death was septic complications, most of them related to prolonged pre-operative cortisone medication. Follow-up examination was possible in 90% of all discharges. Five-year recurrence rate was 37.6%. Recurrence was not prevented by long-term drug treatment. Purely macroscopic assessment of the resection margins would have led to excision within diseased gut: for this reason frozen sections are recommended before the anastomosis is made. Primary death-rate in 30 cases of colectomy with primary ileorectostomy was 3%. In three patients the rectum had to be excised, while in one the anastomosis had to be taken down because of recurrence. The failure rate was thus only 11%. If rectoscopy, stepwise biopsy and intra-operative frozen section indicate a normal rectum it is recommended that ileorectostomy be done rather than diversion ileostomy with occlusion of the rectum or even proctocolectomy.