In spite of the growing variety of materials being used in the manufacture of intraabdominal packs (sponges), no data have been published on their adhesion-producing properties. We have shown that the Porton rat will reliably produce peritoneal adhesions in response to ischaemia and glove powder. In a randomized control trial using this rat model, we tested the adhesogenic potential of two commercially available surgical packs. Both brands of pack were shown to cause a significant incidence of postoperative peritoneal adhesions ( P I S less than 0.005), irrespective of whether the packs were used wet or dry. It is recommended that the adhesogenic potential of all products for use within the peritoneal cavity be established in an animal model prior to marketing.

As part of the Adelaide Obesity Surgery Study, we have reviewed all patients who have undergone revisional surgery. Of the 31 0 trial patients, 63 (20%) had revisions 1-69 (median 32) months following their original surgery-30% of all 105 gastrogastrostomy (GG) operations, 22% of 106 gastroplasty (GP) procedures, and 9% of 99 gastric bypasses (GB). Failure was due to stomal dilatation, 11% of all trial patients (71% of GG revisions), stomal stenosis, 6% (52% of GP revisions) and staple dehiscence, 4%. There was no mortality and a low hospital morbidity. Long-term success was only 23% (follow-up at least 3 years) and was achieved at considerable expense (3 reversals, 10 further revisions, 44 endoscopic procedures). Revisional surgery was successful in 45% of patients with stomal dilatation or dehiscence but in only 17% with stenosis. Overall, the most successful operation was revision of, or conversion to, gastric bypass (58% success rate), compared with gastroplasty (24%) and gastrogastrostomy (25%). Our long-term results following revisional surgery were disappointing, particularly for stenosis, and most failures followed revision to GG or GP. Roux-en-Y gastric bypass is the procedure of choice when considering revision.

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S Section ofProctology 713 rather than upon half of them while they are desperately ill. Summary(1) The outcome of any attack of colitis depends on the severity of the attack, the extent of disease and the age of the patient at the time.(2) If surgery is to be used in a severe attack, it should be in the early stages. (3) Total involvement of the colon implies such a poor prognosis that prophylactic proctocolectomy may be justified in these patients. It may also be justified in patients over 60 even if the large bowel is not totally involved.

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