Neoplasms of the anus.

Anal cancers can be grouped into three major categories. First, anal margin lesions are usually well-differentiated, keratinized squamous cell carcinomas that are amenable to local treatment measures. Second, anal canal cancers distal to the dentate line are mostly epidermoid, nonkeratinizing, moderately differentiated tumors. They are usually best treated with a multimodality approach using chemoradiotherapy and reserving surgery for clinical failures. Third, cancers arising in the ATZ are usually adenocarcinomas, and their treatment depends upon local factors. APR is in order for locally aggressive lesions, but newer protocols are studying multimodality therapy for this entity as well. Other, less common cancers of this region should be evaluated based upon their biologic potential and local involvement, with treatments selected accordingly.

Simple technique for anvil insertion in stapled circular colorectal anastomoses.

The benefits of circular stapling devices are obvious. The introduction of staplers with detachable anvils has simplified the stapling procedure even more than the original instruments. A simple technique for placing the anvil and pursestring are described.

Transcolonoscopic decompression of sigmoid volvulus.

Colonoscopy may decompress a sigmoid volvulus above the reach of a rigid sigmoidoscope. Intraluminal stenting to prevent early recurrence can be accomplished using flexible plastic tubing passed over the colonoscope.

Transanal rectovaginal fistula repair.

In this update, 15 additional successful transanal repairs followed for one to six years postoperatively for low rectovaginal fistulas without colostomies are added to the uniformly successful 20 patients presented in a 1978 report. Changes in perioperative routines have greatly enhanced cost efficiency and these modifications are enumerated. The repair still encompasses total excision of the epithelialized fistula, and reapproximation of the attenuated septal fibers and anal sphincter mechanism, as well as the caudad rectal mucosal advancement that covers and protects the repair from the fecal stream and the high intraluminal pressures of defecation. Once again, we have excluded inflammatory, neoplastic, and irradiation-caused fistulas from this discussion, although we, as well as others, have applied this technique in selected cases.

The EEA stapler in low colorectal anastomoses: initial experience.

The initial experience of several colonic and rectal surgeons with the EEA stapling device for low colorectal anastomoses is reviewed. It was found that the EEA gives a better anastomosis than is possible by hand and that a surgeon familiar with doing a low anterior resection can perform it on patients for whom it is not possible by hand. However, the results with the EEA are not perfect or guaranteed. The many complications associated with its use are reviewed, and ways to avoid them are discussed.

Glucagon, a useful adjunct in anastomosis with a stapling device.

Spasm of the proximal sigmoid colon has been a major hindrance in the use of the EEA stapler in low anterior resections. Intravenous glucagon, by causing rapid relaxation and hypotonicity of the sigmoid colon, appears to help correct this problem and allows for a safer and more atraumatic anastomosis.

Colonic adrenocarcinomas in patients with ureterosigmoidostomies.

Two additional cases of adenocarcinoma of the sigmoid colon occurring at the site of ureterosigmoidostomy are reported. The high risk of this complication occurring in patients who have undergone ureterosigmoidostomy is described. The possible shortness of the interval from diversion to development of an adenocarcinoma, especially in those cases involving carcinoma of the bladder, is emphasized. It is strongly recommended that careful follow up of such patients should begin within several years of establishment of the ureterosigmoidostomy.

Leiomyosarcoma of the rectum: radical vs. conservative therapy and report of three cases.

Three cases of leiomyosarcoma of the rectum are presented. A review of the literature appears to indicate that there is little relationship between Broders' pathologic classification and survival. Size of the tumor, presence of ulceration of the rectal mucosa, and fixation of the lesion appear to have a significant relationship to survival. In appropriately selected patients (no ulceration or fixation, small size), local excision appears to offer as good a chance of survival as abdominoperineal resection.

Presacral myelolipoma: report of a case and review of the literature.

A benign presacral tumor composed of adipose and hematopoietic tissue was found in an asymptomatic 47-year-old woman. Due to the patient's associated medical conditions the tumor was diagnosed by transanal biopsy and was not removed. Only three similar cases have been reported.

Suture-line recurrence in carcinoma of the colon and rectum.

Seventy-three patients with adenocarcinoma of the sigmoid, rectosigmoid and rectum were reviewed to determine the incidence of suture-line recurrence. Four patients (5.5 per cent) developed suture-line recurrence despite the use of a number of techniques to reduce this problem. All four recurrences were in patients who had Dukes' C lesions of the rectum. It would appear that such recurrences are not related to implantation factors alone.