Omental pedicle graft rectopexy for rectal procidentia: preliminary report of a new method.

Twenty-six patients with rectal procidentia were satisfactorily treated by omental pedicle graft. Ten patients had anterior resection in addition to the omental pedicle graft procedure. There was no mortality and the morbidity was low. This is a preliminary report of the procedure. The entity of internal procidentia remains ill-defined, but with new demonstrative techniques it may become clearer and receive greater attention. The omental pedicle graft procedure is recommended for cautious trial because of the short follow-up period.

Postoperative anorectal bleeding.

Forty-three postoperative anorectal bleeding episodes were encountered in the treatment of 4,059 anorectal operations, an incidence of 1.06 per cent. One-third of the postoperative bleeding occurred within the first 48 hours and reflects technical errors; nearly half of the bleeding occurred from the seventh to the 11th postoperative days; the cause of this delayed bleeding remains obscure.

Sloughage of the anus and lower rectum following aortic graft replacement: report of a case.

The successful management of a near-complete sloughage of the anal outlet following aortic graft replacement is reported. Oxygenation in the immediate postoperative period along with appropriate antibiotics may be beneficial in preventing such sloughage. Embolic phenomena or bacterial growth, or both, may have been factors in causing the extensive sloughage.

Iatrogenic supralevator fistula.

This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.

Focal dermal hypoplasia (Goltz's syndrome) manifesting as condyloma acuminatum: report of a case and review of the literature.

A new case of Goltz's syndrome, focal dermal hypoplasia, is documented. The literature is reviewed. The composite individuality warrants considering Golt'z syndrome a separate syndrome in the ectodermal dysplasias. Caution against diagnosing "condyloma-like" lesions occurring in ectodermally dysplastic patients as condyloma acuminatum is urged. Neoplastic transformation and the tendency to recurrence after surgical exicision of the cutaneous angiofibromas pose a difficult problem in surgical management.

Simplified anterior resection: Use of the ta stapler.

Forty consecutive anterior resections using TA stapler were studied. No mortality, no clinical leak, and no infection were encountered in this group. The stapler is recommended as an aid in simplifying the operation and lessening the operative time.