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A review of closure of Hartmann's colostomy was undertaken to establish guidelines for the timing and technique of reversal. Between 1984 and 1990 there were 69 reversals; 48 patients originally had diverticular disease and 21 had carcinoma. One-third underwent reversal before 4 months and two-thirds after this time. The operative mortality rate was 3 per cent and the anastomotic leak rate 4 per cent. Significant morbidity occurred in 30 per cent. There was no advantage in delayed closure. Complications occurred in 24 per cent of patients undergoing reversal before and 35 per cent undergoing reversal after 4 months. Thirty-five anastomoses were hand-sewn and 34 stapled. There were no differences in operating time for the two techniques, but a greater number were stapled after 4 months than before (P less than 0.05), which may reflect increased rectal stump shrinkage with time. There were no differences in complication rates whether the anastomosis was hand-sewn (34 per cent) or stapled (26 per cent). Closure of Hartmann's colostomy is a safe procedure but has a significant morbidity in nearly one-third of cases. On the basis of these results, there is no indication to delay closure after 4 months have elapsed, and earlier reversal, when the rectal stump is most accessible, is recommended.

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SUMMARY The increase in stool weight after feeding 20 g (dry weight) of bran daily was measured when this was of large particle size and after milling to small particle size. Twenty-eight investigations were carried out in 21 normal subjects. With coarse bran, stool weight was significantly greater than with the fine bran (mean 219-4 g/d coarse bran, 199-0 g/d fine bran: difference 20-4 g SE + 6-4, P < 0.01). The coarse bran also had a greater water-holding capacity (7.3 g water/g coarse bran, 3.9 g water/g fine bran). Coarse bran was 21 times the volume of fine bran for a given weight and more fine bran will, therefore, be taken when bran is prescribed by the spoonful.Wheat bran is now consumed in large quantities as a concentrated form of dietary fibre supplement. Different varieties are available varying in palatability, fibre content, and particle size (Southgate, 1976a, b). It has been suggested that particle size is important in determining the therapeutic effectiveness of bran (Kirwan et al., 1974). The finer it is, the less its water-holding capacity , and the more susceptible in may be to bacterial digestion within the colon (Nutritional Reviews, 1975). A study was, therefore, carried out to determine whether a change in particle size alone affects the laxative properties of bran. MethodTwenty-one volunteers, nine men and 12 women, measured their daily stool weight before, during, and after eating coarse and fine bran. This was carried out a total of 28 times, as several subjects repeated the study. The volunteers, aged 20 to 40 years, were doctors, science lecturers, nurses, paramedical staff, technicians, and medical students.A large quantity of extremely coarse bran was carefully blended and then half of this was hammermilled very finely with no further extraction. Both varieties were sterilised in dry heat at 160°C for one hour and were subsequently sterile on culture. The water content of each bran was determined, and the bran divided into portions equivalent to 20 g dry weight in self-sealing plastic bags.A normal diet was eaten for the first week of the study and all stool specimens were weighed using spring balances which had previously been checked as accurate to the nearest gram. One type of bran