Objective To evaluate the influence of preoperative abstinence on postoperative outcome in alcohol misusers with no symptoms who were drinking the equivalent of at least 60 g ethanol/day. Design Randomised controlled trial. Setting Copenhagen, Denmark. Subjects 42 alcoholic patients without liver disease admitted for elective colorectal surgery. Interventions Withdrawal from alcohol consumption for 1 month before operation (disulfiram controlled) compared with continuous drinking. Main outcome measures Postoperative complications requiring treatment within the first month after surgery. Perioperative immunosuppression measured by delayed type hypersensitivity; myocardial ischaemia and arrhythmias measured by Holter tape recording; episodes of hypoxaemia measured by pulse oximetry. Response to stress during the operation were assessed by heart rate, blood pressure, serum concentration of cortisol, and plasma concentrations of glucose, interleukin 6, and catecholamines. Results The intervention group developed significantly fewer postoperative complications than the continuous drinkers (31% v 74%, P = 0.02). Delayed type hypersensitivity responses were better in the intervention group before (37 mm 2 v 12 mm 2 , P = 0.04), but not after surgery (3 mm 2 v 3 mm 2 ). Development of postoperative myocardial ischaemia (23% v 85%) and arrhythmias (33% v 86%) on the second postoperative day as well as nightly hypoxaemic episodes (4 v 18 on the second postoperative night) occurred significantly less often in the intervention group. Surgical stress responses were lower in the intervention group (P<0.05). Conclusions One month of preoperative abstinence reduces postoperative morbidity in alcohol abusers. The mechanism is probably reduced preclinical organ dysfunction and reduction of the exaggerated response to surgical stress.

Anorectal function was studied in 13 patients with carcinoma of the rectum 6-12 cm from the anal verge, which was treated by low anterior resection (LAR), and in 13 age- and sex-matched control subjects. Patients were studied before and 3 and 12 months after operation. Anal resting and squeeze pressures were the same in patients and control subjects and were decreased only moderately after surgery, with a slight increase in maximum squeeze pressure 12 months after operation. Three of the patients had an inverse rectoanal reflex before operation, and two had no reflex at all. After operation, only two patients showed a normal rectoanal inhibitory reflex, and none gained a normal reflex within 12 months after surgery. Rectal compliance was significantly reduced before operation, compared to control subjects, and was still significantly lower 3 months after operation. After 12 months, however, rectal compliance had returned to preoperative level in all but two patients with coloanal anastomosis, who still emptied the bowel 4-5 times daily.

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The physiological variation in anal manometry using a perfused catheter with radiating sideholes was studied in 78 healthy volunteers. The maximum intraindividual variation in the length of the anal high pressure zone, resting pressure and squeeze pressure was 10 mm, 26 mmHg and 68 mmHg respectively. The median 95 per cent confidence interval for length of the pressure zone was 4 mm; for resting pressure it was 15 mmHg and for squeeze pressure it was 48 mmHg. Day-to-day variation did not exceed the intraindividual variation. Constant recording with the catheter fixed in the high pressure zone revealed slow waves and ultraslow waves with amplitudes of 6-24 mmHg which could account for most of the intraindividual variation. No sex difference was found in the length of the high pressure zone whereas resting pressure and squeeze pressure were higher in men than in women. Although a tendency towards a decrease in the length of the high pressure zone, resting pressure and squeeze pressure was observed with increasing age, no significant age-related difference could be demonstrated.