Obstructing carcinoma of the left colon: treatment by extended right hemicolectomy.

Obstructing carcinoma of the left side of the colon causes proximal distension of the colon with subsequent thinning of the colonic wall and vascular impairment. Conventional surgical treatment is multi-staged. Each stage carries its own morbidity and mortality. An alternate treatment, extended right hemicolectomy, requires a single surgical procedure. Fifty-six cases of acute obstructing carcinoma of the left colon are presented: 16 in Group I were treated conventionally; 40 in Group II were treated by extended right hemicolectomy. In Group I, four died within one week of surgery. Six survived with a colostomy; all suffered from poor quality of life until death. For the six who received complete treatment, average total hospitalization was 54 days. Group II suffered no peri-operative mortality. Patients were discharged without a colostomy after an average hospitalization of 15.7 days. Advantages of and conditions for treatment by extended right hemicolectomy are discussed.

[Staging of rectal carcinoma by endorectal ultrasonography].

Staging of rectal carcinoma is essential for its management. 23 patients with rectal lesions were examined by endorectal ultrasonography. Of these 19 had rectal carcinoma and in 4 there was an abscess of the rectal wall, previously diagnosed by sigmoidoscopic biopsy. 10 of those with carcinoma were examined by computerized tomography as well, and 10 were operated on. In most cases the staging of rectal carcinoma by endorectal ultrasonography was accurate and compared well with the operative histological results. We conclude that endorectal ultrasonography is the method of choice for staging of rectal carcinoma prior to treatment.

Gastric bypass operation in morbid obesity.

During the period 1979-80, 20 patients with morbid obesity underwent a gastric bypass procedure in our department. The selected patients were under 50 years old and were overweight by 45 kg or more. Previously, all the patients had unsuccessfully followed prolonged dietary regimes, some had tried dental splinting, and one had undergone three unsuccessful jejunoileal bypasses. The surgical technique used in two cases was transection of the stomach and gastrojejunostomy. In 18 cases, a gastric stapling procedure was performed. the upper gastric pouch was restricted to 5% of the entire stomach, and the gastrojejunostomy was limited to a 12-mm diameter. In the case with the failed jejunoileal bypass, dismantling of the intestinal bypass, reanastomosis, and a gastric bypass were performed in one stage. Weight loss averaged 8 kg/month for three months after the intervention, and then decreased to 2 to 4 kg/month. Laboratory studies after 6 and 12 months showed no deviation from normal. The use of the gastric bypass procedure, which does not involve metabolic complications or serious side effects, in refractory obesity results in a satisfactory long-term weight reduction, and an improvement in the quality of life.

Post-thrombotic leg ulcer and its surgical treatment.

The post-thrombotic syndrome is a complex disease to whose development at least three factors contribute: (1) incompetence of the venous valvular system; (2) opening of the local arteriovenous shunts; and (3) disturbances in the lymphatic system. Our surgical treatment considers all three factors by providing: (1) stripping of the saphenous veins; (2) wide excision of the ulcerated region with the fascia, followed by immediate skin graft; and (3) large excision of subcutaneous tissue and fascia. Of fifty-one patients with chronic post-thrombic leg ulcers operated on according to these principles, only one had recurrence, a recurrence rate of only 0.5%. This compares favorably with other published results.