The technique of sliding flap advancement for the treatment of high anal fistulae is described. The technique is not suitable for cases with an acute abscess and is reserved for patients with a well-established chronic fistula track. Thirty patients with anal fistulae were treated by sliding flap advancement from 1980 to 1984. Twenty-nine patients had satisfactory results. With a follow-up ranging from 18 months to 4 years no recurrence of fistulae or abscess were observed. The advantages of the advancement flap technique over the staging division technique with application of a seton and over the rerouting technique are discussed.

In the past five years, routine CEA determinations have been carried out on all patients after curative operation for colorectal carcinoma. These patients also underwent a clinical follow-up examination in the Oncology Outpatient Department. In 86 patients, recurrence of a tumor was confirmed. In 31 cases, a second-look operation was carried out. The CEA determinations were retrospectively analyzed in these patients and correlated with the time the recurrence of the tumor was diagnosed. These results show that of 86 patients only 15 (17.4 per cent) had pathologic CEA values before clinical symptoms of tumor recurrence. In the patient group with local recurrence, only 11 (23.9 per cent) of 46 patients had previously pathologically raised CEA values. Of 31 patients, 15 (48.4 per cent) underwent curative resection after the second-look operation. At this time, 12 patients (38.7 per cnt) still had normal CEA values, whereas only three patients (9.7 per cent) had pathologically raised CEA values. From these results, it was established that early diagnosis of tumor recurrence was very low. Therefore, one should not rely more on postoperative routine CEA determinations in the postoperative monitoring of patients following curative operations for colorectal carcinoma than on regular comprehensive follow-up examinations of these patients.

Formerly it was considered dangerous to undertake resection in the presence of colonic obstruction. This idea has been abandoned. Immediate right hemicolectomy is the accepted treatment for obstructed lesions of the right colon. For obstruction of the left colon proximal colostomy or caecostomy are being challenged by immediate resection as a Hartmann operation with iliac colostomy or finished with a colo-colonic or colo-rectal anastomosis. A subtotal colectomy with ileo-sigmoid or ileo-rectal anastomosis is a further method with encouraging experiences. From 1979-1984 a series of 33 patients with obstruction from a carcinoma of the left colon underwent emergency abdominal colectomy with primary ileosigmoidostomy or ileorectostomy without diversion. The mortality and morbidity was favourable compared with those reported in series of similar cases treated by stages procedures or primary resection. Several advantages of this method are explained and further encouraging experiences from other centers are reported.

Plastic Sm'gical Procedures in Ano-Rectal DiseaseSummary. The indication for our 483 plastic surgical procedures in ano-rectal disease were mucosal prolapse, 3rd degree hemorrhoids combined with mucosal prolapse, ectropium, anal stenosis, large perianal tumors, high transsphincteric anal fistulae and small rectovaginal fistulae. We performed these procedures by Parks operation of anal reconstruction, V-Y-plasty, Ferguson's S-plasty in large perianal tumors and advancement flap technique in high transsphincteric fistulae and rectovaginal fistulae.