Progress in Proctology: Proceedings of the 3rd International Congress of Hedrologicum Conlegium October 1968, Erlangen-Nuremberg, Germany

257 Pages·1969·6.118 MB·English

by  J. F. Montague (auth.), Dr. J. Hoferichter (eds.)

Progress in Proctology
Proceedings of the 3rd International Congress
of H edrologicum Conlegium
October 1968, Erlangen-Nuremberg, Germany
Editor: J. Hoferichter
Springer-Verlag Berlin Heidelberg New York 1969
ISBN-13: 978-3-642-87961-6 e-ISBN-13: 978-3-642-87959-3
DOl: lO.l007/978-3-642-87959-3
All rights reserved. No part of this book may be translated or reproduced in any form
without written permission from Springer-Verlag. © by Springer-Verlag Berlin Heidel
berg 1969.
Softcover reprint ofthe hardcover 1s t edition 1969
The use of general descriptive names, trade marks, etc. in this publication, even if the
former are not especially identified, is not be taken as a sign that such names, as
understood by the Trade Marks and Merchandise Act, may accordingly be used freely
by anyone.
Title-No. 1601
Preface
"Hedrology" - a term coined by G. B. E. SIMONETTI (Milan) - is the oldest of
all surgical specialities. It was re-introduced as Proctology by European surgeons
at the turn of the century. Excellent work was performed by the surgeons LIS
FRANK, DIEFFENBACH, VELPEAU, VOLKMANN, KRASKE, VON REINEKE, QUENU,
REHN and GOETZE.
Today this specialty includes the research, recognition and treatment of
disorders of the entire colon, rectum and anus. Ever since the days of W. VON
REINEKE (1868-1901), this specialty has been cultivated with special care at the
Chirurgische Universitatsklinik Erlangen; scientific investigation has progressed
and the operative technique has been improved.
Experts from 22 countries met here at the Third International Congress in order
to exchange experience and to learn from the successes and failures of their col
leagues.
These opinions and this knowledge have been summarized in the congress
report. Thus it presents a survey of today's problems in proctology.
G. REGEMANN
President of the
3rd International Congress
Contents
The Future of Proctology, J. F. MONTAGUE . 1
I. Injuries of the Colon and Rectum
Injuries of the Colon and Rectum, J. HOFERICHTER ... 4
Complications of Proctoscopy and Irrigoscopy, P. A. HAAS 16
Barium Peritonitis, H. DITTRICH . . . . . . . . . . . 19
II. Anal Fistulas
A Pictorial History of Surgical Treatment of "Fistula-in-Ano",
G. B. E. SIMONETTI . . . . . . . . . . . . 21
Fistula-in-Ano, H. R. THOMPSON . . . . . . . . . . . . . . 26
The Classification of Fistula-in-Ano, A. G. PARKS. . . . . . . 30
The Prevention of Anal Fistulas by the Correct Treatment of Anal Abscesses
and Phlegmons, U. MAREL, A. DAVY and G. CAYRON ........ 36
Chronic Abscesses of the Ano-Rectum, N. J. GEORGIADIS and B. LEOUTSAKOS 39
Systematic Anal Sphincter Resection and Immediate Myorrhaphy in High
Anal Fistula Exeresis - Technique and Results, R. SCHWARTZ. . . . . . 42
Gross Rectal Involvement in Crohn's Disease, T. P. COLE, S. W. B. EWEN and
J. KYLE . . . • . . . . . . . . . . . . . 44
Anal Fistulas in Regional Enteritis, J. SCHIER . . 47
Anal Fistula in the Adult and Child, P. ROMUALDI 51
III. Chronic Obstipation
Surgical Treatment of Chronic Obstipation, M. REIFFERSCHEID . . . . 55
Current Problems in Constipation, R. OTTENJANN 61
Psychosomatic Aspects in Chronic Constipation, J. M. GARRIGUES and
C. A. BRUERE-DAWSON. . . . . . . . . 64
Sigmoid Fixation Syndrome, T. WILENSKY 69
The Pathology of Megacolon, W. MEIER-RuGE 72
Surgery of Megacolon, R. MORGER . . . . . 78
The Surgical Treatment of Megacolon, K. SCHWEMMLE. 82
IV. Incontinentia Alvi
Problems of Continence in Atresia Ani and Congenital Megacolon, F. REHBEIN 84
Electrical Treatment of Anal Incontinence and Rectal Prolapse Using an
External Stimulator with Intra Anal Electrodes, B. R. HOPKINSON and
R. LIGHTWOOD . . . . . . . . . . . . . . . . . . . . . . . . . 88
VI Contents
Surgical Tactics in the Treatment of Rectal Sphincter Insufficiency,
J. M. MATYASHIN and V. V. BUKHTEYEV . . . . . . . . . . . . . . 93
Myokinetic Sphincterplasty with Incontinentia Alvi After Anal and Rectal
Atresia, R. DAUM and W. CH. HECKER. . . . . . . . . . . . . . . 95
V. Colon Polyps and Cancer Relationship
Colonic Polyps and Carcinoma Risk, F. DEUCHER, F. NOTHIGER and
A. WIDMER . . . . . . . . . . . . . . . . . . . . . . . . . 99
Incidence of Polyps and Carcinomas in the Colon and Rectum in Current Autopsy
Material, K. ARAKAwA ...................... 106
Statistical Analysis of Polyps of the Colon and Rectum in Japan with Consid
eration of their Malignant Degeneration, S. YAMAGATA, H. WATANABE,
T. TAKEBE and T. NABASAKA . . . . . . . . . . . . . . . . . . . 110
Adenomatous Polyps of the Rectum and Recto-Sigmoid - Benign and Malig-
nant - Surgical Management, W. H. BERNHOFT ........... 116
Problems in the Histological Diagnosis of Polyps of the Colon, K. ELSTER and
K. ARNOLD . . . . . . . . . . . . . . . . . . . 120
Classification and Therapy of Colon Polyps, H. SCHAUDIG . . . . . . . . 124
Hypersecretory Villous Tumor of the Colon, I. DEGRELL. . . . . . . . . 129
Malignant Transformation of Diffuse Polyposis of the Colon, Gy. BARADNAY,
G. PETRI and V. VA BRO . . . . . . . . . . . . . . . . . .. 132
Familiar Polyposis Coli, K. ARNOLD, G. KEMMERER and R. ZITZMANN. 136
VI. Cancer
Social Acceptability of the Colostomy - the Surgeon's Task and Duty,
K. DENECKE and R. HELLBACH . . . . . . . . . . . . . . . . . . 140
A Plea for Primary Hemicolectomy in Perforated Cancer of the Right Colon,
C.-A. MULLER. . . . . . . . . . . . . . . . . . . . . . . . . . 143
Carcinoid Tumours, W. F. W. SOUTHWOOD 148
SituationofEndorectalIrradiation in the Curative Treatment of Rectum Cancer
at the Outset, J. PAPILLON .................... 151
Some Consideration on the Operative Treatment of Cancer of the Rectum,
B. KRESTEV, ST. KIROV and ZL. DUDUNKOV . . . . . . . . 155
VII. Colitis, Diverticulitis, Proctitis
The Surgical Treatment of Ulcerative Colitis, F. GALL and J. v. D. EMDE. 158
One-Stage Proctocolectomy with Anal Ileostomy, S. DROBNI . . . .. 162
Surgical Treatment of Nonspecific Ulcerative Colitis, I. M. MATYASHIN. 165
Primary Syphilis of the Anorectal Region, B. SAMENIUS . . . . . .. 167
A Case of Pseudo-Cancerous Endometriosis of the Rectal-Vaginal Wall -
Radiography and Therapy, J. M. GARRIGUES and Y. ALQUIER. .. 171
Colon Biopsy in Undiagnosed Chronic Amoebiasis, Th. DOXIADIS and
Z. YIOTSAS . . . . . . . . . . . . . . . . . . . . . 174
Ulcerative or Amoebic Colitis 1 TH. DOXIADIS and Z. YIOTSAS . . .. 180
Contents VII
Diverticulitis, Diverticulosis Coli, P. KYRLE and R. LEITNER. . . . . . . 186
Diverticular Disease of the Colon in Greece, EJh PHOCAS, N. MOSCOUTIS,
D. GIANNACOS and C. NICOLAIDIS . . . . . . . . . . . . . . . . . 190
V I I I. Diagnostic Procedures
The Present State of Radiodiagnostics of the Colon and Rectum, J. ALTARAS
and G. BARTH ......................... 194
Scintigraphy in the Preoperative Diagnosis of Rectal Carcinoma, K. KEMINGER 198
Scintigraphy of the Colon, A. D' ADDABBO, A. CAPURSO, M. BONOMO,
G. GAETANI and M. RUBINO. . . . . . . . . . . . . . . . . . . . 202
Angiographic and Microangiographic Patterns of Colonic Lesions, P. PELTO-
KALLIO and T. V. KALIMA . . . . . . . . . . . . . . . 209
Color Photography of the Colon with a Gastrocamera, P. PELTOKALLIO,
Y. PERTTALA and U. SVINHUFVUD . . . . . . . . . . . . . . . . . 212
A Study of the Resorption of 131JNa from the Normal and Pathological Rec
tum, AD. KERESZTESSY K., A. PuPP, Z. PAPAl, E. BANcu, AM. KERESZ-
TESSY, T. GROZESCU and N. COMAN . . . . . . . . . . . . . 215
Proctosigmoidoscopy in Colon Diseases, TH. DOXIADIS, Z. YIOTSAS and
T. PALEOLOGOS . . . . . . . . . . . . . ....... 218
IX. Proctology
Proctological Consultation, J. GUSINDE . . . . . . . . . 224
Clinical Manifestations of Anorectal Disease, G. H. THIELE 227
Rectal Anatomy with Clinical Significance, E. LEVY 231
Non-Radical vs. Radical Anorectal Surgery, T. F. MORAN . 233
Surgical Management of Strangulated, Thrombosed Hemorrhoids as an Emer-
gency Procedure, D. A. ZAMBOURAS, A. 1. TRAMPAKLOS and S. TSILIVIDIS 236
CataclysInic Rectorrhagia of Unusual Cause: the Myeloma, J. LENTINI,
E. FORNELLS and R. ORTIZ. . . . . . . . . . . . . . . . . . . . 239
A Method for the Adequate Preparation of Rectoscopic Examinations,
A.. ALFOLDY and M. FEHER . . . . . . . . . . . . . . . . . . . . 245
Contributors
ALQUIER, Y., Dr., Rue de la Petite Loge, Montpellier, France
ALFOLDY, A., Dr., Hospital Joannes and Ambulance, Budapest, Hungary
ALTARAS, J., Dr., Privatdozent fur Rontgenologie, Wilhelm-Conrad-Rontgen-
klinik, Giessen, Germany
ARAKAWA, K., M.D., Arakawa Surgical Clinic, Tokyo, Japan
ARNoLD, K., Dr., Chirurgische Klinik der Universitat, Erlangen, Germany
BANcu, E., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu-Mure~,
Roumania
BARADNAY, Gy., Dr., I. Surgical Clinic of University, Medical School, Szeged,
Hungary
BARTH, G., Dr., Dr., Professor fur Rontgenologie, Wilhelm-Conrad-Rontgen
klinik, Giessen, Germany
BERNHOFT, W. H., M.D., Assistant Clinical Professor, Department of Surgery,
Division of Proctology, State University of New York, Buffalo, N.Y., USA
BONOMO, M., Dr., Istituto di Clinica Medica, Universita di Bari, Bari, Italy
BRuERE-DAwsoN, C. A., Dr., Rue de la Petite Loge, Montpellier, France
BUKHTEYEV, V. V., Dr., Gorky Street 154, fl. 14., Donetsk, 55, USSR
CAPURSO, A., Dr., Istituto di Clinica Medica, Universita di Bari, Bari, Italy
CAYRON, G., Dr., Hopitaux de Paris Membre de la Societe Fran~aise de Procto-
logie, Rouen, France
COLE, T. P., M.B., F.R.C.S., Department of Surgery, Woodend General Hospital,
Aberdeen, Great Britain
COMAN, N., M.D., Radiologic Institute, University of Tirgu-Mure~, Tirgu-Mure~,
Roumania
D'ADDABBo, A., Dr., Professor of Medicine, Istituto di Clinica Medica, Universita
di Bari, Bari, Italy
DAUM, R., Dr., Privatdozent fUr Chirurgie, Kinderchirurgische Abteilung der
Chirurgischen Klinik der Universitat, Heidelberg, Germany
DAVY, A., Dr., 5, Rue d'Ecosse, Rouen, France
DEGRELL, I., Dr., Dozent fur Chirurgie, Megyei, Tamics Korhaza, Zrinyi Miklos u.
1. sz., Zaelaegerszeg, Hungary
DENEcKE, K., Dr., Professor fUr Chirurgie, Stadtische Krankenanstalten, Furth,
Germany
DEUCHER, F., Dr., Professor fUr Chirurgie, Chirurgische Klinik des Kantonsspitals
Aarau, Aarau, Switzerland
DITTRICH, H., Dr., Privatdozent fiir Chirurgie, Chirurgische Klinik der Universi
tat, Erlangen, Germany
DOXIADIS, TH., M.D., Professor of Medicine, Evangelismos Medical Center, Athens
Greece
x
Contributors
DROBNI, S., Dr., IV. Szamu Esbeszeti Klinika Sziv-es Ersebeszet, Budapest.,
Hungary
DUDUNKOV, Z., Dr., Surgical Section, Oncological Institute "Darvenitza", Sofia,
Bulgaria
ELSTER, K., Dr., Professor fUr Pathologie, Pathologisches Institut der Universitiit,
Erlangen, Germany
v. D. EMDE, J., Dr., Chirurgische Klinik der Universitiit, Erlangen, Germany
EWEN, S., M.D., Department of Surgery, Woodend General Hospital, Aberdeen,
Great Britain
FEHER, M., Dr., Hospital Joannes and Ambulance, Budapest, Hungary
FORNELLS, E., Dr., University School of Barcelona, Department of Proctology,
Barcelona, Spain
GAETANI, G., Dr., Istituto di Clinica Chirurgica, Universita di Bari, Bari,
Italy
GALL, F., Dr., Professor fur Chirurgie, Chirurgische Klinik der Universitiit,
Erlangen, Germany
GARRIGUES, J. M., Dr., Rue de la Petite Loge, Montpellier, France
GEORGIADIS, N. J., M.D., Associated Professor of Surgery, 3, Koumbari Street,
Athens, Greece
GIANNACOS, N., M.D., Assistant Professor, Department of Radiology, St. Sophias
Children Hospital, Athens, Greece
GROZESCU, T., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu-Mure~,
Roumania
GUSINDE, J., Dt·., Chirurgische Klinik der Universitiit, Erlangen, Germany
HAAS, P., Dr., Orvostov Abbkepz6 Intezet, Sebeszeti Transzeke, Budapest,
Hungary
HECKER, W. CR., Dr., Professor fiir Chirurgie, Kinderchirurgische Abteilung der
Chirurgischen Klinik der Universitiit, Heidelberg, Germany
HELLBACH, R, Dr., Stiidtische Krankenanstalten, Fiirth, Germany
HOFERICHTER, J., Dr., Privatdozent fur Chirurgie, Chirurgische Abteilung des
Stadtkrankenhauses, Wolfsburg, Germany
HOPKINSON, B. R, M.D., F.RC.S., Queen Elizabeth Hospital, Edgbaston,
Birmingham, Great Britain
KALIMA, T., M.D., II. Surgical Clinic, University of Helsinki, Helsinki, Finland
KEMINGER, K., Dr., Universitiitsdozent, I. Chirurgische Universitiitsklinik, Wien,
Austria
KEMMERER, G., Dr., Chirurgische Klinik der Universitiit, Erlangen, Germany
KERESZTESSY, AD., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu
Mure~, Roumania
KERESZTESSY, AM., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu
Mure~, Roumania
KIROV, ST., Dr., Surgical Section, Oncological Institute "Darvenitza", Sona,
Bulgaria
KRESTEV, B., Dr., Professor, Surgical Section, Oncological Institute "Darvcnitza",
Sofia, Bulgaria
KYLE, J., M.D., Department of Surgery, Woodend General Hospital, Aberdeen,
Great Britain
Contributors XI
KYRLE, P., Dr., Universitats-Professor, Krankenanstalt Rudolfstiftung der Stadt
Wien, II. Chirurgische Abteilung, Wien, Austria
LEITNER, R, Dr., Krankenanstalt Rudolfstiftung der Stadt Wien, II. Chirurgische
Abteilung, Wien, Austria
LENTINI, J., Dr., University School of Barcelona, Department of Proctology,
Barcelona, Spain
LEOUTSAKOS, B., M.D., King Paul Hospital, University of Athens, Athens, Greece
LEVY, E., M.D., 1749 Grand Concourse, Apt. 8, New York, N.Y., 10453, USA
LIGHTWOOD, R, M.D., Surgical Research Laboratories of the Queen Elizabeth
Hospital, Birmingham, Great Britain
MAREL, U., Dr., 45, Rue d'Elbeuf, Rouen, France
MATYASHlN, I. M., Dr., Professor fUr Chirurgie, Lesja Ukrainka Boulevard, Kiew,
USSR
MEIER-Rt:"GE, W., Dr., Privatdozent, Pathologisches Institut der Universitat,
Basel, Switzerland
MONTAGUE, J. F., M.D., 104 East 40th Street, New York, N.Y., 10016, USA
MORAN, T. F., M.D., Medical Arts Building, 327 North Washington Avenue,
Scranton, Pa., USA
MORGER, R, Dr., FMH Chirurgie, Kinderchirurgie, Ostschweizerisches Sauglings
und Kinderspital, St. Gallen, Switzerland
MOSKOUTIS, N., M.D., Consultant Gastroenterologist, Evangelismos Medical
Center, Athens, Greece
MULLER, CH. A., Dr., Specialiste F.M.H. Chirurgie, Lausanne, Switzerland
NARASAKA, T., M.D., Department of Internal Medicine, Tohoku University,
School of Medicine, Sendai, Japan
NICOLAIDIS, C., M.D., Consultant Gastroenterologist, Department of Clinical
Therapeutics, University of Athens, Athens, Greece
NIEMIRO, B. J., M.D., Pleasant Street 575, Holyoke, Mass. 01040, USA
NOTHIGER, F., Dr., Chirurgische Klinik des Kantonsspital Aarau, Aarau, Switzer
land
ORTIZ, R, Dr., University School of Barcelona, Department of Proctology,
Barcelona, Spain
OTTENJANN, R., Dr., Privatdozent fur Medizin, Medizinische Klinik der Universi
tat, Erlangen, Germany
PALEOLOGOS, T., M.D., Evangelismos Medical Center, Athens, Greece
PAPAl, Z., Dr., Professor, 1. Surgical Clinic of University of Tirgu-Mure~, Tirgu
Mure~, Itoumania
PAPILLON, J., Dr., Professeur a la FaculM Itadiologiste de Hopitaux, 12, Quai
General-sarrail, Lyon, France
PARKS, A. G., M.Ch., F.R.C.S., St. Mark's Hospital, London, Great Britain
PELTOKALLIO, P., M.D., II. Surgical Clinic, University of Helsinki, Helsinki,
Finland
PERTALLA, Y., M.D., II. Surgical Clinic, University of Helsinki, Helsinki, Finland
PETRI, G., Dr., Professor of Surgery, I. Surgical Clinic, University Medical School,
Szeged, Hungary
PHOCAS, EL., M.D., I. Medical Clinic, University of Athens, School of Medicine,
Athens, Greece
XII Contributors
PUPP, A., Dr., I. Surgical Clinic, University ofTirgu-Mure~, Tirgu-Mure~, Roumania
REHBEIN, F., Dr., Professor fur Chirurgie, Kinderchirurgische Klinik, Bremen,
Germany
REIFFERSCHEID, M., Dr., Professor fur Chirurgie, Abteilung fur Allgemeine
Chirurgie der Medizinischen Fakultat an der Rheinisch-Westfalischen Tech
nischen Hochschule, Aachen, Germany
ROMUALDI, P., Dr., Professor, Ospedale del Bambino, Gesu, Roma, Italy
RUBINO, M., Dr., Istituto di Clinica Chirurgica, Universita di Bari, Bari,
Italy
SAMENIUS, B., M.D., Department of Surgery I, Sahlgrenska Sjukhuset, Gothen
burg, Sweden
SCHAUDIG, H., Dr., Privatdozent fUr Chirurgie, Chirurgische Klinik des Kreis-
krankenhauses, Bad Mergentheim, Germany
SCIDER, J., Dr., Chirurgische Klinik der Universitat, Mainz, Germany
SCHWARTZ, R, Dr., 172 Bd. Haussmann, Paris, France
SCHWEMMLE, K., Dr., Chirurgische Klinik der Universitat, Erlangen, Germany
SIMONETTI, G. B. E., Dr., Via S. Raffaele 3, Milano, Italy
SOUTHWOOD, W. F. W., M.D., Upton House, Bathwick Hill, Bath, Somerset,
Great Britain
SVINHUFVUD, U., M.D., II. Surgical Clinic, University of Helsinki, Helsinki,
Finland
TAKEBE, T., M.D., Department of Internal Medicine, Tohoku University, School
of Medicine, Sendai, Japan
THIELE, G. H., M.D., Plaza Time Building, 411 Nichols Road, Kansas City,
Missouri 64112, USA
THOMPSON, H. R, Mr., F.RC.S., 14, Devonshire Place, London W. 1, Great
Britain
TRAMPAKLOS, A. I., M.D., General State Hospital Agia Olga, II. Surgical Division,
Athens, Greece
TSILIVIDIS, S., M.D., General State Hospital Agia Olga, II. Surgical Division,
Athens, Greece
VA RR6, V., Dr., I. Surgical Clinic of University, Medical School, Szeged, Hungary
WATANABE, H., M.D., Department of Internal Medicine, Tohoku University,
School of Medicine, Sendai, Japan
WIDMER, A., Dr., Chirurgische Klinik des Kantonsspital, Aarau, Aarau, Switzer
land
WILENSKY, T., M.D., 701 North Logan Street, East Lansing, Mich. 48915, USA
YAMAGATA, S., M.D., Professor of Medicine, Department of Medicine, Tohoku
University, School of Medicine, Sendai, Japan
YIOTSAS, Z., M.D., Evangelismos Medical Center, Athens, Greece
ZAMBOURAS, D. A., M.D., General State Hospital Agia Olga, II. Surgical Division,
Athens, Greece