TEM resection of neoplasms located on the lateral rectal wall have a higher risk of bleeding. The learning curve for transanal endoscopic microsurgery appears to be negligible in surgeons with experience in minimal invasive surgery.

After ileostomy construction for Crohn's disease reoperations due to ileal recurrences are thought to be unusually rare, whereas reconstructions of the ileostomy due to stoma complications are considered to be unusually frequent. It remains unclear why the natural course of a disease as well as outstanding results of a standardized surgical procedure should be perverted. Therefore reconstructions of the ileostomy in 92 patients colectomized during a 12.5-year period and followed up for 5.4 years were analyzed concerning preoperative indication and postoperative histology. In 28 patients (30.4%) a total of 42 reoperations were necessary. The clinical indication was prestomal recurrence in 5 reoperations (11.9%) and stoma complications in 37 (88.1%). In contrast, ileal recurrence was demonstrated histologically in 28 specimens (66.7%) and healthy ileum in the rest. There was a statistically significant association between fibrotic recurrence and stoma stenosis/retraction and a trend for association between penetrating recurrence and peristomal ulceration. The cumulative risk for a first reoperation due to clinical recurrence was calculated at 3.3% and 14.0% at 5 and 10 years postoperatively, whereas the corresponding figures for stoma complications were 25.7% and 40.0%. In contrast, the cumulative risk that a recurrence was found histologically on the occasion of the reoperation was 23.0% and 35.0%, while the probability that the ileum was healthy in the case of a stoma complication remained low. In conclusion, most reoperations after ileostomy-construction in Crohn's disease are associated histologically with recurrent inflammation. The accentuation of the inflammatory recrudescence at the stoma itself or the prestomal ileum is decisive for the clinical presentation as stoma complication or intestinal complication. These findings reinforce both well known characteristics of the inflammatory disease and of established surgery.

Ten patients with primary gastric non-Hodgkin's lymphoma (NHL) were preoperatively assessed by endoscopic ultrasonography (EUS). Tumor infiltration depth and lymph node involvement were assessed using the TNM classification system. EUS was 80% accurate in determining the TL stage and 90% in detecting lymph node metastases (NL stage). Based on the longitudinal tumor extent (antrum to fundus), as assessed by preoperative (n = 10) and additionally, intraoperative EUS (n = 3), partial gastric resection was performed in nine patients and total gastrectomy in one. All resection specimens had tumor-free resection margins (R0 resection rate 100%). These results were compared to those in 23 patients with gastric NHL operated on prior to the introduction of EUS in the hospital who were comparable with respect to tumor location and extent. In comparison with the ten cases where treatment was guided by EUS, the rate of total gastrectomy was higher (65% versus 10%) and the R0 resection rate lower (72% versus 100%) in this group of 23 patients. These results show that EUS may play a crucial role in the pre-surgical staging of gastric NHL.

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Altered ulcer manifestation, minimized surgical therapy and improved intensive care medicine led to a recent reduction in postoperative mortality of patients suffering from perforated or bleeding gastroduodenal ulcer. A further reduction of this still high mortality might be expected by improvement of surgical training and/or restriction of therapy to a limited number of surgeons.