Table Of ContentColo-rectal Surgery
Edited by
G. Heberer and H. Denecke
With 91 Figures and 89 Tables
Springer-Verlag
Berlin Heidelberg New York 1982
Proceedings of the
Anglo-German Proctology Meeting
Munich, May 14/15, 1981
Prof. Dr. med. Georg Heberer
Direktor der Chirurgischen Universitatsklinik Miinchen
Priv.-Doz. Dr. med. Heiko Denecke
Oberarzt der Chirurgischen Universitatsklinik. Miinchen
KI~nikum Grb6hadern, Marchioninistr. 15
D-8000 Miinchen 70, Federal Republic of Germany
ISBN-13: 978-3-540-11505-2 e-ISBN-13: 978-3-642-81828-8
DOl: 10.1007/978-3-642-81828-8
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Composition: Schreibsatz Service Weihrauch, Wiirzburg
2124/3321-543210
Contents
List of Contributors ......................................... IX
Introduction. G. Heberer ..................................... ,
The Pathology of Megacolon. B. Smith. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Pathology of Hirschsprdng's Disease and Ischaemic Colitis. B. Wiebecke . . . . . . . 5
Surgery for Constipation. E.S.R, Hughes, F.T. McDerniott, W.R. Johnson, and
A.L. Polg1ase .......~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Idiopathic Megacolon. J.P. Todd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Hirschsprung's Disease. H.H. Nixon ..... ',' . . . . . . . . . . . . . . . . . . . . . . . . 23
Experience with Low Anterior Resection in Hirschsprung's Disease. W.Ch. Hecker 29
Complications After Surgical Treatment of Hirschsprung's Disease.
A.M. Holschneider ........................................... 33
Pseudo-Obstruction of the Colon. V. Zumtobel, T. Sauerbruch, and D. Inthorn .. 43
Acute Pseudo-Obstruction of the Large Bowel. N.V. Addison . . . . . . . . . . . . . . 47
Toxic Megacolon. P.R. H;twley .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Survival Prospects After Sphincter-Saving Operations. E.S.R. Hughes,
F.T. McDermott, W.R. Johnson, E.A. Pihl, and A.B. Price ................ 51
Continent Ileostomy. N.E. Kock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Indication for the Erlanger Magnetic Device. K. Schwemmle . . . . . . . . . . . . . . . 61
Sphincteroplasty Using Autologous Smooth Muscle. E. Schmidt . . . . . . . . . . . . 67
Experience of a New Hydraulic Sphincter Prothesis. G. Szinicz . . . . . . . . . . . . . 73
v
The Postanal Repair Operation in Unselected Patients with Idiopathic Faecal
Incontinence. A. Lewis and M. Lewis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Internal Sphincter Dysfunction: A Cause of Idiopathic Megacolon. R.H.S. Lane. . 83
A Comparison of Infrared Coagulation and Conventional Methods in the Treatment
of Haemorrhoids. R.I. Leicester ................................. 89
The Conservative Treatment of Haemorrhoidal Complaints. 1.1. Kirsch. . . . . . . . 93
Lord's Procedure for Haemorrhoids: A Prospective Anal Pressure Study.
B.D. Hancock ............................................. 99
Ileo-Anal Pouch Operation. S.A. Parks .. . . . . . . . . . . . . . . . . . . . . . . . . . .. 105
The Use of Circular Staplers for the Construction of Colorectal Anastomoses After
Anterior Resection. 1.C. Goligher ................................ 107
Stapler Anastomoses in the Low Rectal Third. H. Hamelmann, A. Thiede,
L. lostarndt, and H. Troidl . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. 115
Comparative Results of Hand and Mechanical Suture in Low Colorectal
Anastomosis. W.D. Fedorov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 127
Low Anterior Resection. G. Heberer .............................. 131
Bowel Preparation Using Antimicrobial Measures. H. Pichimaier ............ 137
Functional Results After Low Anterior Resection. H. Denecke and R. Wirsching 143
Colorectal Anastomosis: Factors Influencing Success. R.E.B. Tagart . . . . . . . . .. 149
Surgery for Anal Carcinoma. F. Deucher . . . . . . . . . . . . . . . . . . . . . . . . . . .. 155
Combined Therapy for Anal Carcinoma. F.W. Eigler, E. Scherer, E. Gross, and
U. Schulz ................................................ 159
Radiotherapy for Anal Carcinoma. R. Sauer ......................... 163
Multimodality Approach in Therapy of Anal Carcinoma. G. Feifel . . . . . . . . . .. 169
"A Disease Revived" - Ileocaecal Tuberculosis. N.V. Addison ............. 175
Ischaemic Proctitis. H. Schwering, B. Lingemann, and K.-M. MillIer .......... 179
The Course and Prognosis of Idiopathic Distal Proctocolitis. A. Munro . . . . . . .. 185
VI
Management of the Solitary Rectal Ulcer Syndrome. C.J. Martin, T.G. Parks
and J.D. Biggart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Assessment and Management of Fistulae in Crohn's Disease. J .C. Givel,
P.C. Hawker, M.R.B. Keighley, R.N. Allan, and J. Alexander-Williams ........ 199
Subject Index ............................................. 202
VII
List of Contributors
N.V. Addison, Bradford Royal Infirmary, Department of Surgery, Duckworth Lane,
Bradford, BD9 6RJ, England
H. Denecke, Chirurgische Klinik der Universitlit, Klinikum Gro~hadem, Marchionistr. 15,
8000 Miinchen 70, Federal Republic of Germany
F. Deucher, Chirurgische Klinik am Kantonspital, 5000 Aarau, Switzerland
F.W. Eigler, Abteilung Allgemeine Chirurgie, Universitlits-Klinikum, Hufelandstr. 55,
4300 Essen, Federal Republic of Germany
G. Feifel, Chirurgische Klinik der Universitiit, Klinikum Grollliadem, Marchionistr. 15,
8000 Miinchen 70, Federal Republic of Germany
W.D. Fedorov, Institut ftir Proktologie der lJniversitiit Moskau, Salam-Adil-Str. 2, Moskau,
U.S.S.R.
F.P. Gan, Chirurgische Universitiitsklinik Erlangen, Krankenhausstr. 12,8520 Erlangen,
Federal Republic of Germany
J.C. Givel, Gastroenterology Unit, The General Hospital, Steelhouse Lane, Birmingham
B4 6NH, England .
J .C. Goligher, The University of Leeds, and St. Mark's Hospital for Diseases of the Rectum
and Colon, City Road, London ECIV 2PS, England
H. Hameimann, Abteilung ftir Allgemeinchirurgie, Universitlitsklinikum, Hospitalstr. 40,
2300 Kiel, Federal Republic of Germany
B.D. Hancock, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, England
P.R. Hawley, St. Mark's Hospital for Diseases of the Rectum and Colon, City Road,
London ECI V 2PS, England
G. Heberer, Chirurgische Klinik der Universitlit, Klinikum Gro~hadem, Marchioninistr. 15,
8000 Miinchen 70, Federal Republic of Germany
IX
W.Ch. Hecker, Kinderchirurgische Klinik der UniversWit, Lindwurrnstr. 4, 8000 Mlinchen 2,
Federal Republic of Germany
A. Holschneider, Kinderchirurgische Klinik der Universitat, Lindwurmstr. 4, 8000 MOO
chen 2, Federal Republic of Germany
E.S.R. Hughes, Monash University Department of Surgery, Alfred Hospital, Commercial
Road, Prahran 3181, Victoria, Australia
J.J. Kirsch, St. Hedwig's Klinik B 2-5,6800 Mannheim 1, Federal Republic of Germany
N.E. Kock, II. Chirurgische Universitatsklinik, Sahlgrenska Sjukhuset, 41345 G6teborg,
Sweden
R.H.S. Lane, Royal Hampshire County Hospital, Romsey Road, Winchester S022 5DG,
England
R.J. Leicester, St. Mark's Hospital for Diseases of the Rectum and Colon, City Road,
London ECI V 2PS, England
A. Lewis, The Royal Free Hospital, Pond Street, London NW3 2QG, England
C.J. Martin, Department of Surgery, Queen's University, Belfast, Northern Ireland
A. Munro, 23 Eriskay Road, Inverness, Scotland
H.H. Nixon, The Hospital for Sick Children, Great Ormond Street, London WC1N 3JH,
England
A. Parks, 33 Alwyne Road, Canonbury, London Nl, England
H. Pichlmaier, Chirurgische Universitatsklinik K6ln, Joseph-Stelzmannstr. 9, 5000 K6ln
41, Federal Republic of Germany .
R. Sauer, Strahlentherapeutische Klinik und Poliklinik der Universitat, Krankenhaus
str. 12,8520 Erlangen, Federal Republic of Germany
E. Schmidt, Chirurgische Universitatsklinik, Josef-Schneiderstr. 2, 8700 Wtirzburg,
Federal Republic of Germany
K. Schwemrnle, Abteilung Allgemeine Chirurgie, Zentrum fUr Chirurgie der Universitat,
Klinikstr. 29, 6300 Gie~en, Federal Republic of Germany
H. Schwering, Chirurgische Klinik der UniversWit, Abteilung Allgemeine Chirurgie,
Jungeblodtplatz 1,4400 Mlinster, Federal Republic of Germany
B. Smith, Department of Pathology, St. Bartholomew's Hospital, Smithfield Road,
London EC1A 7BE, England
x
G. Szinicz, II. Universitatsklinik fur Chirurgie, Anichstr. 35,4020 Innsbruck, Austria
R.E.B. Tagart, Newmarket General Hospital, Exning Road, Newmarket CB8 7JG, Eng
land
I.P. Todd, Department of Surgery, St. Mark's Hospital for Diseases of the Rectum and
Colon, City Road, London ECIV 2PS, England
B. Wiebecke, Pathologisches Institut der Universitiit, Thalkirchner Str. 3, 8000 Miinchen 2,
Federal Republic of Germany
V. Zumtobel, Chirurgische Klinik der Ruhruniversitat, St.Josefspital, Gudrunstr. 56,
4630 Bochum, Federal Republic of Germany
XI
G. Heberer/H. Denecke (eds.)
Colo-rectal Surgery
© Springer-Verlag 1982
Introduction
G. Heberer
Surgery of the anus including proctology in a wider sense' and colorectal surgery have
advanced rapidly within the past years. New developments, techniques and llnportant
contributions in this field came especially from surgeons in Great Britain. I am glad that
the Anglo-German Proctology Meeting, organized by the Royal Society of Medicine, Sec
tion of Proctology, and the Department of Surgery of the University here in Munich
this year, provided an opportunity to discuss not only the latest results, but also the
issues of research in pathology, anatomy and experimental surgery with our British collea
gues.
This symposium begins with the topic "Megacolon" as a symptom of various etiolo
gy. It includes not only Hirschsprung's disease, but also constipation, idiopathic megaco
lon, pseudo-obstruction and toxic megacolon in inflammatory bowel diseases. Further
main sessions deal with "Rectal and Anal Anastomoses" with special interest in suture
techniques and the latest concepts of the "Treatment of Anal Carcinoma", including
surgical, radiological and multimodality approaches. The topics of "Sphincter Dysfunc
tion and Hemorrhoids" and "Special Aspects in Inflammatory Diseases" also gave inte
resting results.
As the authors are experts in their fields I am very happy that their contributions
can be demonstrated to an even greater audience with the help of Springer-Verlag.
Munich, Autumn 1981 G. Heberer
