The need for protective transverse colostomy in low anterior resection using the EEA stapler was tested in a randomized series of 50 patients, half of whom received peroperative protective colostomy. Gastrografin enema on the tenth postoperative day showed a leakage frequency of 30 per cent in both groups. Clinical leakage was noted in 4 per cent (one patient) in the colostomy group and 12 per cent (three patients) in the noncolostomy group. Protective colostomy was followed by stenosis in nine instances, compared with only two in the noncolostomy group (2 alpha = 0.05). Routine protective colostomy should not be used in low anterior resection when the EEA stapling instrument is used. The occasional clinical leakage, which may appear in the postoperative period, can be revealed by close observation and successfully treated by an emergency colostomy. The majority of patients with anterior resection of the rectum, therefore, can be spared the inconvenience and cost of temporary colostomy.

Despite sophisticated diagnostic equipment and modern surgical therapy, the prognosis for patients with colorectal carcinoma has not improved during the last few decades. One of the factors, possibly contributing to the prognosis, is the time between the patient's visit to the doctor and the final therapy. In order to estimate patients' and doctors' delay and to investigate the factors which may influence the time of delay, a prospective study was designed including 50 patients with carcinoma of the rectum or the sigmoid colon and 50 patients with colonic carcinoma above this level. All patients were interviewed by a doctor using a standard questionnaire, and initial symptoms, duration of symptoms, and type of clinical examination leading to diagnosis were recorded. The results show that 16% of the patients in the recto/sigmoid group suffered from patient's delay as opposed to 20% in the group of patients with carcinoma above 25 cm from the anal verge. Doctor's delay was found in 27% of all cases, being evenly distributed in the two groups. The reason for doctor's delay was usually the doctor's neglecting to perform rectosigmoidoscopy or rectal palpation, and in some cases a false-negative X-ray. No significant correlation was found between tumor stage and doctor's or patient's delay.