The case notes of all patients treated for ulcerative colitis by colectomy and ileorectal anastomosis at the Gordon Hospital under the care of Mr S. O. Aylett from 1952 to 1976 have been reviewed. Three hundred and seventy-four patients left hospital with an ileorectal anastomosis and have been followed for periods up to 23 years. Twenty-two patients are known to have developed a carcinoma of the rectum. Within 10 years of the onset of the disease, no rectal carcinoma was found in 3534 patient-years. The risk was 1 in 185 patient-years between the tenth and twentieth years and 1 in 115 patient-years between the twentieth and thirtieth years. The cumulative risk was 6 per cent (+/- 2 per cent) at 20 years and 15 per cent (+/- 4 per cent) at 30 years. The need for meticulous follow-up is emphasized. The finding of dysplasia in rectal mucosal biopsies will, it is hoped, identify the patient at particularly high risk and enable rectal excision to be undertaken before carcinoma develops.
Forty consecutive patients scheduled for either low anterior resection or abdominoperineal resection of the rectum have been studied. After standard procedures, carried out by all grades of surgeons, the omentum was mobilized as a pedicle graft based on the left gastro-epiploic arcade and transposed to the pelvis or perineum. All wound were closed primarily without drainage. Twenty-six patients had anterior resection, 11 abdominoperineal resection and 3 an extended Hartmann's operation. Patients were assessed clinically and radiographically by Gastrografin enema and ultrasound for evidence of anastomotic leakage, pelvic collections and wound healing. After anterior resection there were three radiological leaks and no overt clinical leaks. One patient had a collection related to a leak. Of 11 perineal wound 8 healed primarily in 2 weeks and all healed by 4 weeks. There was no frank wound breakdown. The three patients who had Hartmann's operations all healed without complication. There were no unavoidable complications of the procedure. Retrocolic omentoplasty is a simple, safe and effective adjunct to rectal surgery. The additional time taken (15-20 min) is well rewarded by sound healing of these operations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.