Four cases of gastrocolic fistula complicating benign gastric ulcer are described, bringing the total number of individually reviewed cases in the English language literature to 108. A review of 30 cases reported in the past 10 years reveals a surprisingly high percentage of young, female patients. Three-quarters of these patients used steroidal or nonsteroidal anti-inflammatory agents. The presence of such fistulae is suspected in patients complaining of weight loss, diarrhoea and faecal vomiting. Small fistulae may not be suspected when overshadowed by other complications of ulcer disease such as bleeding or perforated viscus. Medical management of benign gastrocolic fistulae may be indicated in some circumstances. Surgical treatment involves en bloc resection, including the fistula, and surrounding colon and gastric segments.

Radiographic, manometric, and clinical techniques were used to assess the functional results after colectomy, mucosal proctectomy, and endorectal ileoanal pull‐through (IAP). In 40 patients with ulcerative colitis, Gardner's syndrome, or familial polyposis, anorectal manometry was performed before IAP and 2 months and 1 year afterward. At 4 weeks after IAP, a standardized water contrast radiograph allowed an estimation of the dimensions of the ileal pouch and the integrity of the ileoanal anastomosis. Radiographically, the mean ± SE length, width, and depth of the ileal pouch were 10.9±0.6 cm, 4.5±0.6 cm, and 3.9±0.2 cm, respectively. No anastomotic leaks were identified; however, 2 patients were incontinent to the contrast material. The mean maximal anal sphincter resting pressure decreased from a mean ± SEM of 87.1±3.2 mmHg preoperatively to 68.1±3.1 mmHg 8 weeks after operation, but by 1 year resting pressure increased to 72.3 ±4.9 mmHg. The change in sphincter pressure with voluntary squeeze was greater 8 weeks after IAP than before the operation (114.0±8.2 mmHg versus 97.7±6.2 mmHg) and increased further by 1 year. No patient experienced major episodes of incontinence. Mean ± SEM stool frequency per 24 hours decreased from 7.5±0.5 at 1 month after ileostomy closure to 6.4±0.7 at 12 months. Ileal pouch capacity increased with time and was inversely related to stool frequency. It was concluded that endorectal pull‐through of an ileal J pouch, by providing an adequate intestinal reservoir and preserving nearly normal anal sphincter function, results in anal continence and acceptable stool frequency.

Background Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30‐day mortality, length of stay, complications, and postoperative outcomes. Results Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II‐III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission ( p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Endorectal ileal pouch-anal anastomosis has become the surgical alternative of choice for patients requiring colectomy for ulcerative colitis or familial polyposis coli. The optimal method of ileal pouch construction has not been determined. In this study, a canine preparation was used to compare the immediate results of three different techniques of ileal J-pouch construction. The three methods studied were two-layer hand-suturing (HS), stapling through enterotomies placed laterally on the ileal limbs (LS), and stapling via an apically placed enterotomy (AS). All three techniques resulted in watertight reservoirs. Ease of construction was scored significantly differently among the pouch variations (AS greater than LS greater than HS). Construction time was significantly less for both of the stapled reservoirs than for the HS pouch. Capacity of the AS pouch was significantly greater than the HS reservoir. This study suggests that stapling the ileal J-pouch through a single apical enterotomy should be the preferred technique during colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis.