No abstract

Two matched groups of 20 patients with bleeding oesophageal varices were treated by the same surgical team by either oesophagogastric transection and anastomosis using a mechanical stapling instrument or by mesocaval portosystemic shunt operation. Five of the patients treated by transection died postoperatively, 2 of the survivors developed portosystemic encephalopathy (PSE), 2 died later and 5 rebled. Seven of the patients who had a mesocaval shunt died postoperalively, 8 developed PSE, 3 died later and 4 rebled. It h concluded that oesophagogastric transection and anastomosis using a mechanical instrument is preferable to portal decompression .for managing bleeding oesophageal varices in the urgent situation.

Ten patients with rectal tumours were treated by cryosurgery. Good palliation without local complications was achieved in the cases of rectal carcinoma and a complete cure followed treatment of benign rectal tumours. Low rectal carcinomas with clinical evidence of dissemination are ideally suited for cryosurgery and complications are minimal. Cryosurgery is a simple, safe procedure which can be performed without a general anaesthetic, and this study indicates that it has a place in the management of rectal tumours.

Two cases are reported of patients presenting with septicaemia as a late complication of a Dacron interposition mesocaval shunt operation. In both cases the prosthesis had eroded through the duodenal wall and the Dacron was in direct contact with intestinal contents. One patient died and the diagnosis was only made at postmortem examination. The other patient recovered after the problem had been recognized and treated surgically.

Statistical comparison of tumour recurrence rate showed no significant difference between treatment groups. Radiotherapy had the lowest recurrence rate (2%), but required an average of 9 out-patient treatment attendances. Excision with primary closure carried the highest recurrence rate (93%), whilst excision with defect closure by flap or graft, which needed a mean in-patient stay of 8-2 days, and cryosurgical treatment had similar recurrence rates of 5 to 6%. Comparing the modes of treatment, cryosurgery was quickest to perform, required no hospitalization and less than 2 out-patient treatment sessions per patient and gave the best cosmetic result. It appears to be a safe technique for treating basal cell cancers and may prove to be the most cost effective method.