[Reinforcement of the peritoneal sack using a large prosthesis (Stoppa operation)]. / Verstärkung des Peritonealsacks mittels grosser Prothese (Operation nach Stoppa).

To avoid repeated dissection and repair of used-up defect margins a truly innovative concept of eliminating recurrent hernias has been introduced by Stoppa. A giant prosthesis of polyester is inserted through a sub-umbilical midline incision and envelopes the inferior visceral sac, which is dissected bilaterally. The prosthesis is held in place against the bony pelvis and abdominal musculature by the pressure of the abdominal viscera and without sutures; it has no slit for the spermatic cord and prevents passage of viscera through a hernial orifice, even left open.

[Bassini operation with polyglycolic acid or polyester. A prospective randomized study of 300 cases]. / Bassini-Operation mit Polyglykolsäure oder Polyester. Eine prospektiv randomisierte Studie an 300 Fällen.

In a prospectively randomized trial polyglycolic acid (PGA) was tested against polyester for recurrence rate in Bassini hernia repair. After a median observation period of 2 years a distinct but statistically insignificant difference was found (12.0% recurrence for PGA against 7.0% for polyester). Within prospectively defined risk groups statistically significant differences were found for men (15.4% PGA, 6.4% polyester) and in the presence of at least one of the risk factors obesity, bronchitis, recurrent hernia, size of hernial sac greater than 8 cm, the last of which being the strongest unfavourable variable for PGA.

[Results of surgical therapy of rectal cancer at a regional hospital]. / Ergebnisse der chirurgischen Therapie des Rectumcarcinoms an einem Regionalkrankenhaus.

The results of surgical treatment of 198 unselected consecutive cases of adenocarcinoma of the rectum at a district hospital between January 1, 1977 and June 30, 1985 are analysed. Characteristics of patients at a primary referral center include old age (47.2% greater than or equal to 70 years) and advanced tumor stage (44.4% Dukes C and D). Despite these unfavourable cohort characteristics tumor excision rate was 97.5%, the proportion of sphincter saving resections 72.0%, using exclusively a single layer hand-sutured technique. Operative mortality was 3.6 and 5.5% for sphincter saving resection and abdomino-perineal excision respectively. The uncorrected cumulative probability of survival at five years is 56.1% for women, 35.0% for men, with a definite advantage for sphincter saving resection in both sexes. Uncorrected cumulative probability of survival according to tumor stage was 72.4% for Dukes stages A and B combined, 30.0% for Dukes C and 0 for D. Where oncologically radical rectal and mesorectal excision is possible from the sole abdominal access, there, hand-sutured abdominal anastomosis is also feasible and advantageous due to resorbable suture material. Taking into account the adversities of unselected patient cohorts, progress is still being achieved in rectal carcinoma surgery without "specialisation" but with improving general surgical and anaesthesiologic techniques.

[One-stage anterior resection in the therapy of high rectovaginal fistulas]. / Einzeitige anteriore Resektion in der Therapie hoher recto-vaginaler Fisteln.

In 7 patients a high recto-vaginal fistula was treated by one-stage anterior resection with hand-sutured anastomosis. The etiology of these fistulas outlines the fact that the peritoneum may wall off an inflammatory process more effectively than the vagina. Even under sterile conditions the peritoneal sealing capacity is an important factor in the healing of the rectal anastomosis. The presented hand-sutured technique takes this full into account.