Published Research

Single-layer bowel anastomoses have conventionally been constructed using an interrupted suture technique. A single-layer continuous technique has been avoided on the grounds that it may predispose to ischaemia of the bowel ends. We have routinely used a single-layer continuous suture technique with an absorbable suture material (polyglycolic acid) to construct all recent intraperitoneal bowel anastomoses, and we present a 3-year audit of this technique.

A total of 131 patients were studied of whom 66 had undergone upper gastrointestinal resections and 65 had had colonic resections. Twenty-two patients had emergency operations. Anastomotic failure was noted in 4.5 and 6.2 per cent of patients in each group respectively. The incidence of minor wound infection was 1.5 and 7.7 per cent respectively. The overall mortality rate was 8.4 per cent.

This study suggests that a single-layer continuous suture technique gives acceptably reliable results when used in gastrointestinal anastomosis.

One hundred and fifty-six thoracic operations have been performed over an 8-year period, from 1980 to 1987, for 118 patients with pulmonary metastases. In 27 instances, the disease has been bilateral requiring a midline approach or sequential lateral thoracotomies. Resection was achieved by wedge excision in 74%, lobectomy in 16%, pneumonectomy in 4%, lobectomy plus wedge excision in 2%, bilobectomy in 1%, segmentectomy in 2% and segmentectomy plus wedge excision in 1%. The operative mortality for the group as a whole was 1.6% per patient (70% confidence limits CL. 0.6%-4.2%) and 1.2% per operation (70% CL. 0.5-3.2%). Actuarial survival for the histological subgroups at 2 and 5 years were: carcinoma 50% (+/- 11% standard error) and 35% (+/- 12%), sarcoma 59% (+/- 10%) and 51% (+/- 12%), teratoma 89% (+/- 5%) and 84% (+/- 7%) respectively. No patient following resection for metastatic melanoma was alive at 2 years. The survival in the teratoma group was significantly higher than in the other groups (P less than 0.001 carcinoma; P less than 0.01 sarcoma; P less than 0.001 melanoma). Survival in all groups was significantly greater than for the melanoma group.

Metastasectomy is well tolerated by the patient. Worthwhile longterm survival is obtained in those patients in whom the primary disease has been controlled and all secondary disease is encompassed by the proposed surgery.

The treatment of venous ulcers has remained largely unchanged for centuries. The application of properly applied graduated compression bandages, the use of graduated compression stockings, and surgery have been shown to achieve healing. However, some ulcers persist despite appropriate management.

A randomized study was undertaken to compare two regimens of treatment for such patients. Both regimens included ulcer debridement, cleaning, nonadherent dressing, and graduated compression stockings. In one regimen, sequential gradient intermittent pneumatic compression was applied for 4 hours each day.

Only one of 24 patients in the control group had complete healing of all ulcers compared with 10 of 21 patients healed in the intermittent pneumatic compression group. The median rate of ulcer healing in the control group was 2.1% area per week compared to 19.8% area per week in the intermittent pneumatic compression group.

The results indicate that sequential gradient intermittent pneumatic compression is beneficial in the treatment of venous ulcers.