[Mucosal flaps in the treatment of anal fistula]. / Lambeaux muqueux dans le traitement des fistules anales.

Results in the treatment of transsphincteric et suprasphincteric fistulae have been greatly improved with the use of mucosal sliding flaps. The aims of this surgical procedure are: division of the fistulous tract from the primary opening within the anal canal, closure of the primary opening to prevent any repermeabilisation of the tract, excision and curettage of fistulous tract without section of the sphincters. Technical details of this procedure and results achieved in the treatment of 30 consecutive cases are reported.

[Treatment of fecal incontinence by overlapping sphincteroplasty]. / Leczenie niewydolnosci zwieraczy odbytu sposobem overlapping.

The authors describe overlapping sphincteroplasty for the reconstruction of injuried anal sphincters. This technique was applied for obstetric, surgical and traumatic injuries i 57 patients. Both anal sphincters were injuried in 37 cases. A single damage of the external sphincter was observed in 20 cases. The anal sphincteric function has been evaluated pre and postoperatively according to Miller's scale (clinical criteria) and by manometry. The manometric studies were performed in 49 patients. Maximal resting tone, maximal squeeze pressure and the anal canal length were studied preoperatively and 6 months after the reconstruction. The functional results were excellent and good in 93% of patients. The improvement of maximal squeeze pressure and anal canal length were statistically significant.

[Personal experiments in treating rectal rumors with the TEM technique]. / Doswiadczenia wlasne w leczeniu guzów odbytnicy technika TEM.

Transanal Endoscopic Microsurgery (TEM) was introduced to clinical practice by Buess in 1983. After several years of gaining experience technique has been used for the excisions of rectal tumours. TEM enables excisions of the tumours localised in the rectum and distal portion of the sigmoid colon from 5 to 25 cm from the anal verge. Until now 13 patients have been operated using TEM method. The group includes also rectal cancers classified as pT-1 and G-1. Preliminary results are encouraging. The patients left the hospital four days after the procedure and started professional activity two weeks postoperatively. All the patients are followed-up: patients who had adenomas once a year and those with pT-1 low-risk rectal cancer-every three months in their first postoperative year and then in six month intervals. Local excision of the adenomas and early cancers of the rectum with the use of TEM proves to be an effective method of surgical treatment in a selected group of patients.

[Local excision of early rectal cancer]. / Miejscowe wyciecie wczesnego raka odbytnicy.

The authors discuss 56 patients operated for rectal cancer primarily estimated as noninvasive. Applied procedures were: local excision through stretched anus /46 cases/, Localio technique /6 cases/, rectotomy during a laparotomy /1 case/ and Transrectal Endoscopic Microsurgery /3 cases/. The patients were divided into 3 groups according to tumor's grading and staging. All patients with cancer infiltration limited to submusosal layer were cured. In the group of infiltrated muscularis layer 36.4% of patients had local recurrences. They were reoperated or irradiated. Two of them died due to cancer spread. The late results in patients with cancer invasion through muscularis layer were poor.

[Evaluation of bacterial flora in patients after intraabdominal surgical procedures throughout a 12 year period]. / Ocena flory bakteryjnej u chorych po zabiegach na jamie brzusznej w okresie 12 lat.

UNLABELLED: The aim of this study was to analyse the composition of the bacterial flora in 295 patients who underwent surgical treatment in our clinic throughout the period of 12 years. 448 specimens were bacteriologically examined. Bacterial pathogens were isolated from 390 (87.1%). Among aerobic bacteria, Enterococcus faecalis was the most often isolated (35.6% - from the peritoneum, 17.8% from the wound). Among anaerobic bacteria, Bacteroides fragilis - 44.9% were the most often isolated. 530 aerobic bacterial strains from Enterococcus, Enterobacteriaceae, Staphylococcus and the nonfermentable rods were carefully analysed. Special attention was paid to the development of the resistance to 3 antibiotics (cefoperazone, ciprofloxacin and gentamycin) in 3 time periods: from 1984 to 1987, from 1988 to 1992 and from 1993 to 1996. Resistance of the bacterial strains to cefoperazone was 38.7% in the first time period; 39.5% in the second; and later increased to 53.8%. Resistance to ciprofloxacin was identical in the first two periods - 10.3%; and subsequently, it increased to 22.6%. The increase of resistance to gentamycin was the most significant--it went up from 24.5% to 44.8 and then dropped to 40.3%. CONCLUSION: Constant monitoring of the bacterial flora enables rational antibiotic application, which is essential due to the observed increase of bacteria strain resistance.

Local excision of rectal carcinoma not-exceeding the muscularis layer.

AIM: The aim of the study was to compare the results of treatment by local excision of two different clinical stages of the rectal cancer. MATERIAL AND METHODS: Fifty-eight patients with early rectal carcinoma were operated on during the last 26 years using different methods of local excision. The carcinomas were initially assessed as not-exceeding the muscularis layer of the rectal wall. The tumours, localized up to 12 cm from the anal margin, were removed by means of "parachute" excision (47 patients). In 6 patients, carcinoma localized in the central part of rectum, was excised by means of the Localio method. Transanal endoscopic microsurgery was applied in 5 cases of carcinoma localized on the depth of 5-20 cm from the anal margin. RESULTS: After local excision the patients were divided into two groups: I, tumours of low degree of malignancy, not exceeding submucosal layer (26 patients); II, tumours of low or median degree of malignancy with infiltration of muscularis layer (32 patients). There was a significant difference in cancer relapses between groups I and II. One patient in group I and 9 in group II developed local recurrences (P < 0.05) and 5 patients in group II had neoplastic dissemination (15.6%). CONCLUSIONS: Best results were obtained in patients with carcinoma not exceeding submucosal membrane. In cases of rectal muscular layer infiltrations, the risk of carcinoma relapses was markedly higher. The use of transanal endoscopic microsurgery has permitted removal of tumours from the upper rectum.

[Mucosal flap in the treatment of anal fistula]. / Lambeaux muqueux dans le traitement des fistules anales.

A technique of sliding flap repair for the treatment of anal fistulae is described. This technique may prevent sphincter damage. Fifty-five consecutive fistulae have been treated: 23 transsphincteric, 26 intersphincteric, 3 suprasphincteric and 3 rectovaginal fistulae. The fistulous tract is excised and cored out. The intersphincteric space is opened: any gland or inflammatory tissue is removed. The internal opening is excised. The gaps in the internal, as well as in the external, sphincter are closed. The endo-anal wound is closed, using a sliding flap of anorectal mucosa. The ischiorectal wound is left open. Healing has been achieved in every case but one within three weeks, without sphincteric functional defect. Only 3 recurrences have been observed in a mean follow-up of 24 months.