Progress in Proctology Proceedings of the 3rd International Congress of H edrologicum Conlegium October 1968, Erlangen-Nuremberg, Germany Editor: J. Hoferichter Springer-Verlag Berlin Heidelberg New York 1969 ISBN-13: 978-3-642-87961-6 e-ISBN-13: 978-3-642-87959-3 DOl: lO.l007/978-3-642-87959-3 All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag. © by Springer-Verlag Berlin Heidel berg 1969. Softcover reprint ofthe hardcover 1s t edition 1969 The use of general descriptive names, trade marks, etc. in this publication, even if the former are not especially identified, is not be taken as a sign that such names, as understood by the Trade Marks and Merchandise Act, may accordingly be used freely by anyone. Title-No. 1601 Preface "Hedrology" - a term coined by G. B. E. SIMONETTI (Milan) - is the oldest of all surgical specialities. It was re-introduced as Proctology by European surgeons at the turn of the century. Excellent work was performed by the surgeons LIS FRANK, DIEFFENBACH, VELPEAU, VOLKMANN, KRASKE, VON REINEKE, QUENU, REHN and GOETZE. Today this specialty includes the research, recognition and treatment of disorders of the entire colon, rectum and anus. Ever since the days of W. VON REINEKE (1868-1901), this specialty has been cultivated with special care at the Chirurgische Universitatsklinik Erlangen; scientific investigation has progressed and the operative technique has been improved. Experts from 22 countries met here at the Third International Congress in order to exchange experience and to learn from the successes and failures of their col leagues. These opinions and this knowledge have been summarized in the congress report. Thus it presents a survey of today's problems in proctology. G. REGEMANN President of the 3rd International Congress Contents The Future of Proctology, J. F. MONTAGUE . 1 I. Injuries of the Colon and Rectum Injuries of the Colon and Rectum, J. HOFERICHTER ... 4 Complications of Proctoscopy and Irrigoscopy, P. A. HAAS 16 Barium Peritonitis, H. DITTRICH . . . . . . . . . . . 19 II. Anal Fistulas A Pictorial History of Surgical Treatment of "Fistula-in-Ano", G. B. E. SIMONETTI . . . . . . . . . . . . 21 Fistula-in-Ano, H. R. THOMPSON . . . . . . . . . . . . . . 26 The Classification of Fistula-in-Ano, A. G. PARKS. . . . . . . 30 The Prevention of Anal Fistulas by the Correct Treatment of Anal Abscesses and Phlegmons, U. MAREL, A. DAVY and G. CAYRON ........ 36 Chronic Abscesses of the Ano-Rectum, N. J. GEORGIADIS and B. LEOUTSAKOS 39 Systematic Anal Sphincter Resection and Immediate Myorrhaphy in High Anal Fistula Exeresis - Technique and Results, R. SCHWARTZ. . . . . . 42 Gross Rectal Involvement in Crohn's Disease, T. P. COLE, S. W. B. EWEN and J. KYLE . . . • . . . . . . . . . . . . . 44 Anal Fistulas in Regional Enteritis, J. SCHIER . . 47 Anal Fistula in the Adult and Child, P. ROMUALDI 51 III. Chronic Obstipation Surgical Treatment of Chronic Obstipation, M. REIFFERSCHEID . . . . 55 Current Problems in Constipation, R. OTTENJANN 61 Psychosomatic Aspects in Chronic Constipation, J. M. GARRIGUES and C. A. BRUERE-DAWSON. . . . . . . . . 64 Sigmoid Fixation Syndrome, T. WILENSKY 69 The Pathology of Megacolon, W. MEIER-RuGE 72 Surgery of Megacolon, R. MORGER . . . . . 78 The Surgical Treatment of Megacolon, K. SCHWEMMLE. 82 IV. Incontinentia Alvi Problems of Continence in Atresia Ani and Congenital Megacolon, F. REHBEIN 84 Electrical Treatment of Anal Incontinence and Rectal Prolapse Using an External Stimulator with Intra Anal Electrodes, B. R. HOPKINSON and R. LIGHTWOOD . . . . . . . . . . . . . . . . . . . . . . . . . 88 VI Contents Surgical Tactics in the Treatment of Rectal Sphincter Insufficiency, J. M. MATYASHIN and V. V. BUKHTEYEV . . . . . . . . . . . . . . 93 Myokinetic Sphincterplasty with Incontinentia Alvi After Anal and Rectal Atresia, R. DAUM and W. CH. HECKER. . . . . . . . . . . . . . . 95 V. Colon Polyps and Cancer Relationship Colonic Polyps and Carcinoma Risk, F. DEUCHER, F. NOTHIGER and A. WIDMER . . . . . . . . . . . . . . . . . . . . . . . . . 99 Incidence of Polyps and Carcinomas in the Colon and Rectum in Current Autopsy Material, K. ARAKAwA ...................... 106 Statistical Analysis of Polyps of the Colon and Rectum in Japan with Consid eration of their Malignant Degeneration, S. YAMAGATA, H. WATANABE, T. TAKEBE and T. NABASAKA . . . . . . . . . . . . . . . . . . . 110 Adenomatous Polyps of the Rectum and Recto-Sigmoid - Benign and Malig- nant - Surgical Management, W. H. BERNHOFT ........... 116 Problems in the Histological Diagnosis of Polyps of the Colon, K. ELSTER and K. ARNOLD . . . . . . . . . . . . . . . . . . . 120 Classification and Therapy of Colon Polyps, H. SCHAUDIG . . . . . . . . 124 Hypersecretory Villous Tumor of the Colon, I. DEGRELL. . . . . . . . . 129 Malignant Transformation of Diffuse Polyposis of the Colon, Gy. BARADNAY, G. PETRI and V. VA BRO . . . . . . . . . . . . . . . . . .. 132 Familiar Polyposis Coli, K. ARNOLD, G. KEMMERER and R. ZITZMANN. 136 VI. Cancer Social Acceptability of the Colostomy - the Surgeon's Task and Duty, K. DENECKE and R. HELLBACH . . . . . . . . . . . . . . . . . . 140 A Plea for Primary Hemicolectomy in Perforated Cancer of the Right Colon, C.-A. MULLER. . . . . . . . . . . . . . . . . . . . . . . . . . 143 Carcinoid Tumours, W. F. W. SOUTHWOOD 148 SituationofEndorectalIrradiation in the Curative Treatment of Rectum Cancer at the Outset, J. PAPILLON .................... 151 Some Consideration on the Operative Treatment of Cancer of the Rectum, B. KRESTEV, ST. KIROV and ZL. DUDUNKOV . . . . . . . . 155 VII. Colitis, Diverticulitis, Proctitis The Surgical Treatment of Ulcerative Colitis, F. GALL and J. v. D. EMDE. 158 One-Stage Proctocolectomy with Anal Ileostomy, S. DROBNI . . . .. 162 Surgical Treatment of Nonspecific Ulcerative Colitis, I. M. MATYASHIN. 165 Primary Syphilis of the Anorectal Region, B. SAMENIUS . . . . . .. 167 A Case of Pseudo-Cancerous Endometriosis of the Rectal-Vaginal Wall - Radiography and Therapy, J. M. GARRIGUES and Y. ALQUIER. .. 171 Colon Biopsy in Undiagnosed Chronic Amoebiasis, Th. DOXIADIS and Z. YIOTSAS . . . . . . . . . . . . . . . . . . . . . 174 Ulcerative or Amoebic Colitis 1 TH. DOXIADIS and Z. YIOTSAS . . .. 180 Contents VII Diverticulitis, Diverticulosis Coli, P. KYRLE and R. LEITNER. . . . . . . 186 Diverticular Disease of the Colon in Greece, EJh PHOCAS, N. MOSCOUTIS, D. GIANNACOS and C. NICOLAIDIS . . . . . . . . . . . . . . . . . 190 V I I I. Diagnostic Procedures The Present State of Radiodiagnostics of the Colon and Rectum, J. ALTARAS and G. BARTH ......................... 194 Scintigraphy in the Preoperative Diagnosis of Rectal Carcinoma, K. KEMINGER 198 Scintigraphy of the Colon, A. D' ADDABBO, A. CAPURSO, M. BONOMO, G. GAETANI and M. RUBINO. . . . . . . . . . . . . . . . . . . . 202 Angiographic and Microangiographic Patterns of Colonic Lesions, P. PELTO- KALLIO and T. V. KALIMA . . . . . . . . . . . . . . . 209 Color Photography of the Colon with a Gastrocamera, P. PELTOKALLIO, Y. PERTTALA and U. SVINHUFVUD . . . . . . . . . . . . . . . . . 212 A Study of the Resorption of 131JNa from the Normal and Pathological Rec tum, AD. KERESZTESSY K., A. PuPP, Z. PAPAl, E. BANcu, AM. KERESZ- TESSY, T. GROZESCU and N. COMAN . . . . . . . . . . . . . 215 Proctosigmoidoscopy in Colon Diseases, TH. DOXIADIS, Z. YIOTSAS and T. PALEOLOGOS . . . . . . . . . . . . . ....... 218 IX. Proctology Proctological Consultation, J. GUSINDE . . . . . . . . . 224 Clinical Manifestations of Anorectal Disease, G. H. THIELE 227 Rectal Anatomy with Clinical Significance, E. LEVY 231 Non-Radical vs. Radical Anorectal Surgery, T. F. MORAN . 233 Surgical Management of Strangulated, Thrombosed Hemorrhoids as an Emer- gency Procedure, D. A. ZAMBOURAS, A. 1. TRAMPAKLOS and S. TSILIVIDIS 236 CataclysInic Rectorrhagia of Unusual Cause: the Myeloma, J. LENTINI, E. FORNELLS and R. ORTIZ. . . . . . . . . . . . . . . . . . . . 239 A Method for the Adequate Preparation of Rectoscopic Examinations, A.. ALFOLDY and M. FEHER . . . . . . . . . . . . . . . . . . . . 245 Contributors ALQUIER, Y., Dr., Rue de la Petite Loge, Montpellier, France ALFOLDY, A., Dr., Hospital Joannes and Ambulance, Budapest, Hungary ALTARAS, J., Dr., Privatdozent fur Rontgenologie, Wilhelm-Conrad-Rontgen- klinik, Giessen, Germany ARAKAWA, K., M.D., Arakawa Surgical Clinic, Tokyo, Japan ARNoLD, K., Dr., Chirurgische Klinik der Universitat, Erlangen, Germany BANcu, E., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu-Mure~, Roumania BARADNAY, Gy., Dr., I. Surgical Clinic of University, Medical School, Szeged, Hungary BARTH, G., Dr., Dr., Professor fur Rontgenologie, Wilhelm-Conrad-Rontgen klinik, Giessen, Germany BERNHOFT, W. H., M.D., Assistant Clinical Professor, Department of Surgery, Division of Proctology, State University of New York, Buffalo, N.Y., USA BONOMO, M., Dr., Istituto di Clinica Medica, Universita di Bari, Bari, Italy BRuERE-DAwsoN, C. A., Dr., Rue de la Petite Loge, Montpellier, France BUKHTEYEV, V. V., Dr., Gorky Street 154, fl. 14., Donetsk, 55, USSR CAPURSO, A., Dr., Istituto di Clinica Medica, Universita di Bari, Bari, Italy CAYRON, G., Dr., Hopitaux de Paris Membre de la Societe Fran~aise de Procto- logie, Rouen, France COLE, T. P., M.B., F.R.C.S., Department of Surgery, Woodend General Hospital, Aberdeen, Great Britain COMAN, N., M.D., Radiologic Institute, University of Tirgu-Mure~, Tirgu-Mure~, Roumania D'ADDABBo, A., Dr., Professor of Medicine, Istituto di Clinica Medica, Universita di Bari, Bari, Italy DAUM, R., Dr., Privatdozent fUr Chirurgie, Kinderchirurgische Abteilung der Chirurgischen Klinik der Universitat, Heidelberg, Germany DAVY, A., Dr., 5, Rue d'Ecosse, Rouen, France DEGRELL, I., Dr., Dozent fur Chirurgie, Megyei, Tamics Korhaza, Zrinyi Miklos u. 1. sz., Zaelaegerszeg, Hungary DENEcKE, K., Dr., Professor fUr Chirurgie, Stadtische Krankenanstalten, Furth, Germany DEUCHER, F., Dr., Professor fUr Chirurgie, Chirurgische Klinik des Kantonsspitals Aarau, Aarau, Switzerland DITTRICH, H., Dr., Privatdozent fiir Chirurgie, Chirurgische Klinik der Universi tat, Erlangen, Germany DOXIADIS, TH., M.D., Professor of Medicine, Evangelismos Medical Center, Athens Greece x Contributors DROBNI, S., Dr., IV. Szamu Esbeszeti Klinika Sziv-es Ersebeszet, Budapest., Hungary DUDUNKOV, Z., Dr., Surgical Section, Oncological Institute "Darvenitza", Sofia, Bulgaria ELSTER, K., Dr., Professor fUr Pathologie, Pathologisches Institut der Universitiit, Erlangen, Germany v. D. EMDE, J., Dr., Chirurgische Klinik der Universitiit, Erlangen, Germany EWEN, S., M.D., Department of Surgery, Woodend General Hospital, Aberdeen, Great Britain FEHER, M., Dr., Hospital Joannes and Ambulance, Budapest, Hungary FORNELLS, E., Dr., University School of Barcelona, Department of Proctology, Barcelona, Spain GAETANI, G., Dr., Istituto di Clinica Chirurgica, Universita di Bari, Bari, Italy GALL, F., Dr., Professor fur Chirurgie, Chirurgische Klinik der Universitiit, Erlangen, Germany GARRIGUES, J. M., Dr., Rue de la Petite Loge, Montpellier, France GEORGIADIS, N. J., M.D., Associated Professor of Surgery, 3, Koumbari Street, Athens, Greece GIANNACOS, N., M.D., Assistant Professor, Department of Radiology, St. Sophias Children Hospital, Athens, Greece GROZESCU, T., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu-Mure~, Roumania GUSINDE, J., Dt·., Chirurgische Klinik der Universitiit, Erlangen, Germany HAAS, P., Dr., Orvostov Abbkepz6 Intezet, Sebeszeti Transzeke, Budapest, Hungary HECKER, W. CR., Dr., Professor fiir Chirurgie, Kinderchirurgische Abteilung der Chirurgischen Klinik der Universitiit, Heidelberg, Germany HELLBACH, R, Dr., Stiidtische Krankenanstalten, Fiirth, Germany HOFERICHTER, J., Dr., Privatdozent fur Chirurgie, Chirurgische Abteilung des Stadtkrankenhauses, Wolfsburg, Germany HOPKINSON, B. R, M.D., F.RC.S., Queen Elizabeth Hospital, Edgbaston, Birmingham, Great Britain KALIMA, T., M.D., II. Surgical Clinic, University of Helsinki, Helsinki, Finland KEMINGER, K., Dr., Universitiitsdozent, I. Chirurgische Universitiitsklinik, Wien, Austria KEMMERER, G., Dr., Chirurgische Klinik der Universitiit, Erlangen, Germany KERESZTESSY, AD., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu Mure~, Roumania KERESZTESSY, AM., Dr., I. Surgical Clinic of University of Tirgu-Mure~, Tirgu Mure~, Roumania KIROV, ST., Dr., Surgical Section, Oncological Institute "Darvenitza", Sona, Bulgaria KRESTEV, B., Dr., Professor, Surgical Section, Oncological Institute "Darvcnitza", Sofia, Bulgaria KYLE, J., M.D., Department of Surgery, Woodend General Hospital, Aberdeen, Great Britain Contributors XI KYRLE, P., Dr., Universitats-Professor, Krankenanstalt Rudolfstiftung der Stadt Wien, II. Chirurgische Abteilung, Wien, Austria LEITNER, R, Dr., Krankenanstalt Rudolfstiftung der Stadt Wien, II. Chirurgische Abteilung, Wien, Austria LENTINI, J., Dr., University School of Barcelona, Department of Proctology, Barcelona, Spain LEOUTSAKOS, B., M.D., King Paul Hospital, University of Athens, Athens, Greece LEVY, E., M.D., 1749 Grand Concourse, Apt. 8, New York, N.Y., 10453, USA LIGHTWOOD, R, M.D., Surgical Research Laboratories of the Queen Elizabeth Hospital, Birmingham, Great Britain MAREL, U., Dr., 45, Rue d'Elbeuf, Rouen, France MATYASHlN, I. M., Dr., Professor fUr Chirurgie, Lesja Ukrainka Boulevard, Kiew, USSR MEIER-Rt:"GE, W., Dr., Privatdozent, Pathologisches Institut der Universitat, Basel, Switzerland MONTAGUE, J. F., M.D., 104 East 40th Street, New York, N.Y., 10016, USA MORAN, T. F., M.D., Medical Arts Building, 327 North Washington Avenue, Scranton, Pa., USA MORGER, R, Dr., FMH Chirurgie, Kinderchirurgie, Ostschweizerisches Sauglings und Kinderspital, St. Gallen, Switzerland MOSKOUTIS, N., M.D., Consultant Gastroenterologist, Evangelismos Medical Center, Athens, Greece MULLER, CH. A., Dr., Specialiste F.M.H. Chirurgie, Lausanne, Switzerland NARASAKA, T., M.D., Department of Internal Medicine, Tohoku University, School of Medicine, Sendai, Japan NICOLAIDIS, C., M.D., Consultant Gastroenterologist, Department of Clinical Therapeutics, University of Athens, Athens, Greece NIEMIRO, B. J., M.D., Pleasant Street 575, Holyoke, Mass. 01040, USA NOTHIGER, F., Dr., Chirurgische Klinik des Kantonsspital Aarau, Aarau, Switzer land ORTIZ, R, Dr., University School of Barcelona, Department of Proctology, Barcelona, Spain OTTENJANN, R., Dr., Privatdozent fur Medizin, Medizinische Klinik der Universi tat, Erlangen, Germany PALEOLOGOS, T., M.D., Evangelismos Medical Center, Athens, Greece PAPAl, Z., Dr., Professor, 1. Surgical Clinic of University of Tirgu-Mure~, Tirgu Mure~, Itoumania PAPILLON, J., Dr., Professeur a la FaculM Itadiologiste de Hopitaux, 12, Quai General-sarrail, Lyon, France PARKS, A. G., M.Ch., F.R.C.S., St. Mark's Hospital, London, Great Britain PELTOKALLIO, P., M.D., II. Surgical Clinic, University of Helsinki, Helsinki, Finland PERTALLA, Y., M.D., II. Surgical Clinic, University of Helsinki, Helsinki, Finland PETRI, G., Dr., Professor of Surgery, I. Surgical Clinic, University Medical School, Szeged, Hungary PHOCAS, EL., M.D., I. Medical Clinic, University of Athens, School of Medicine, Athens, Greece XII Contributors PUPP, A., Dr., I. Surgical Clinic, University ofTirgu-Mure~, Tirgu-Mure~, Roumania REHBEIN, F., Dr., Professor fur Chirurgie, Kinderchirurgische Klinik, Bremen, Germany REIFFERSCHEID, M., Dr., Professor fur Chirurgie, Abteilung fur Allgemeine Chirurgie der Medizinischen Fakultat an der Rheinisch-Westfalischen Tech nischen Hochschule, Aachen, Germany ROMUALDI, P., Dr., Professor, Ospedale del Bambino, Gesu, Roma, Italy RUBINO, M., Dr., Istituto di Clinica Chirurgica, Universita di Bari, Bari, Italy SAMENIUS, B., M.D., Department of Surgery I, Sahlgrenska Sjukhuset, Gothen burg, Sweden SCHAUDIG, H., Dr., Privatdozent fUr Chirurgie, Chirurgische Klinik des Kreis- krankenhauses, Bad Mergentheim, Germany SCIDER, J., Dr., Chirurgische Klinik der Universitat, Mainz, Germany SCHWARTZ, R, Dr., 172 Bd. Haussmann, Paris, France SCHWEMMLE, K., Dr., Chirurgische Klinik der Universitat, Erlangen, Germany SIMONETTI, G. B. E., Dr., Via S. Raffaele 3, Milano, Italy SOUTHWOOD, W. F. W., M.D., Upton House, Bathwick Hill, Bath, Somerset, Great Britain SVINHUFVUD, U., M.D., II. Surgical Clinic, University of Helsinki, Helsinki, Finland TAKEBE, T., M.D., Department of Internal Medicine, Tohoku University, School of Medicine, Sendai, Japan THIELE, G. H., M.D., Plaza Time Building, 411 Nichols Road, Kansas City, Missouri 64112, USA THOMPSON, H. R, Mr., F.RC.S., 14, Devonshire Place, London W. 1, Great Britain TRAMPAKLOS, A. I., M.D., General State Hospital Agia Olga, II. Surgical Division, Athens, Greece TSILIVIDIS, S., M.D., General State Hospital Agia Olga, II. Surgical Division, Athens, Greece VA RR6, V., Dr., I. Surgical Clinic of University, Medical School, Szeged, Hungary WATANABE, H., M.D., Department of Internal Medicine, Tohoku University, School of Medicine, Sendai, Japan WIDMER, A., Dr., Chirurgische Klinik des Kantonsspital, Aarau, Aarau, Switzer land WILENSKY, T., M.D., 701 North Logan Street, East Lansing, Mich. 48915, USA YAMAGATA, S., M.D., Professor of Medicine, Department of Medicine, Tohoku University, School of Medicine, Sendai, Japan YIOTSAS, Z., M.D., Evangelismos Medical Center, Athens, Greece ZAMBOURAS, D. A., M.D., General State Hospital Agia Olga, II. Surgical Division, Athens, Greece