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Background: Anal incontinence in young women is often caused by sphincter rupture from obstetric injury or anal fistula surgery., Material and Methods: From 1992 to 1997, 17 women were operated for anal sphincter injury at Aker University Hospital, Oslo, Norway. Data were obtained retrospectively from patient files., Results: In 13 patients, the anal incontinence was caused by obstetric injury and in four by anal fistula surgery. In all patients the external anal sphincter was repaired with overlap technique. In addition, plication of the puborectalis muscle was performed in 15 patients, perineoplasty in eight, vaginoplasty in one and operation for genital prolapse in one. Nine patients had a temporary loop sigmoidostomy. 12 of 16 patients for whom postoperative symptoms had been recorded, reported improved anal continence. Eight of these had complete anal continence, whereas four still experienced some incontinence for gas and loose stools. On clinical examination, 11 patients had normal resting sphincter pressure and voluntary sphincter contraction. Six had weak voluntary contraction; two of these had normal resting sphincter pressure., Interpretation: Traumatic anal sphincter injuries in young patients can seriously impair anal function. Results of surgical treatment are satisfactory in most patients.

Background: The aim of this study was to examine whether the functional result of restorative proctocolectomy for ulcerative colitis deteriorated by postponing follow-up from three to eight years after pouch surgery., Material and Methods: All patients (n = 58) operated for ulcerative colitis from 1984-97, who still had intact reservoir, responded to a questionnaire on defecating pattern, stool leakage, perianal irritation, urinary function, workload, sexual life, social life, and the patient's opinion on outcome. The results for the first 29 patients were compared to last 29 patients operated. Median follow-up was eight for the first 29 patients and three years for the last 29., Results: There were no significant difference in functional outcome and patient opinion after pouch surgery between the first 29 and last 29 patients (n = 58). Respective figures for median 24-hour stool frequency were 7.0 and 6.3, leakage of stool 48% and 38%, ability to defer defecation 86% and 97%, perianal irritation 59% and 48%, use of antidiarrhoeal medication 55% and 52%, and wearing of pad 28% and 38%. Sexual life (n = 57) had improved for 11 (19%) and deteriorated for seven patients (12%). Potency was reduced in five (15%) and ejaculation in four patients (12%), one of whom (3%) had retrograde ejaculation. Three (5%) had received a disability pension and five (9%) had reduced workload. After the pouch operation 48 (91%) felt better and three (6%) felt worse because of frequent bowel emptying (n = 3), perianal eczema (n = 1) and pouch fistula (n = 1)., Interpretation: The results do not demonstrate any significant deterioration of functional outcome after pouch surgery for ulcerative colitis by postoperative increase of follow-up from three to eight years.

During the period 1985-92, 181 patients were treated at Aker Hospital for diverticulitis of the colon. 106 patients (59%) were treated conservatively, and 75 (41%) were operated on for complications. The mortality among the patients treated conservatively was 4.7%. 47 patients underwent operation in the acute stage, most often for perforation or intestinal obstruction, and the most frequent operation was the Hartmann procedure. 28 patients had an elective operation, the most common indication being a fistula from the colon. In this group the operation was usually resection with anastomosis. After acute operation, 17 patients (36%) experienced surgical complications, and the mortality was 12.8% (six patients). After elective operation the morbidity was low (2/28), and the mortality was nil. Our preferred principle for acute surgery for diverticulitis is colonic resection. This eliminates the source of contamination, and allows debridation and cleansing of the peritoneum.

Surgical treatment of Crohn's disease is an alternative when the symptoms are not adequately relieved by drugs. The initial result of intestinal resection is usually good, but in most cases the disease re-occurs after varying periods of time. The article describes a study of the long-term results of surgical treatment. 58 patients were followed up 10-25 years after surgery. 38% had been re-operated within ten years, and 54% within 15 years. None of the patients had been re-operated more than 15 years after the initial operation. After an average observation time of 18 years, 35% had no symptoms, and 65% had symptoms probably caused by Crohn's disease. Of the 17 patients with no clinical symptoms at follow-up, 11 had been re-operated once or several times. Only six of the patients were symptom-free without reoperation. The authors conclude that, although a permanent cure of Crohn's disease is rarely achieved by surgery, it is a valuable form of treatment for patients with incapacitating symptoms.

Achalasia was diagnosed in 57 patients from 1982 through 1991. 13 patients were evaluated by manometry both before and after pneumatic dilatation of the sphincter. There were no serious complications. All but one patient experienced good symptomatic effect; one patient was operated after two ineffective dilatations. The tonus and length of the lower oesophageal sphincter decreased significantly, but dilatation did not improve the swallow-induced relaxation of the sphincter, nor peristalsis in the oesophageal body. In three randomly selected patients, transcutaneous nervous stimulation did not have any symptomatic effects, nor did it affect the motility pattern of the oesophagus. Pneumatic dilatation of the lower oesophageal sphincter is a safe and effective first-choice treatment for achalasia, with myotomy being reserved for patients whose symptoms are not relieved successfully after two dilatations.

During the period 1982-91, 52 patients were treated for rectal prolapse. We present the results for 25 treated with Delorme's operation and 14 with rectopexy, all of whom were observed for more than 12 months after operation. Four patients who had internal prolapse were treated with rectopexy. Eight (15%) of 52 patients had postoperative complications, including six in the Delorme group and two in the rectopexy group. A 75 year-old woman operated with rectopexy died from peritonitis. Eight patients (32%) developed recurrent prolapse after Delorme's operation. Five of these were successfully reoperated. No patients in the rectopexy group had a recurrent prolapse. Incontinence and bleeding were reduced in both groups. Despite a relatively high rate of recurrence, we consider Delorme's operation to be a good alternative, also for old debilitated patients, and to involve a minimal risk of serious complications. If recurrence occurs, reoperation can be carried out with good results.

From 1980 to 1989, 46 patients underwent surgery for pathological gastro-oesophageal reflux disease; 28 with Nissen technique, nine with Hill technique and nine with a modified Belsey technique. 11 patients (24%) experienced postoperative complications, 21% after Nissen, 33% after Hill and 22% after Belsey. Two of six patients suffered recurrence of their reflux symptoms after Belsey, three of six after Hill and two of 26 (8%) after Nissen. 85% experienced no reflux symptoms after Nissen fundoplication. 17 patients suffered from flatulence, three were not able to belch and two were not able to vomit. Median lower oesophageal sphincter pressure before Nissen fundoplication was 6.0 mmHg and length was 2.0 cm. After the operation the pressure increased to 10.0 mmHg and the length to 3.0 cm. Four patients underwent ambulatory 24-h oesophageal pH monitoring both preoperatively and postoperatively. The preoperative registration was pathological in all patients, but in three patients the postoperative pH was normal.

A research project initiated in 1978 comprised establishment of a national polyposis registry, a genetic linkage study using classical and DNA markers, an in vitro study of fibroblasts for transformation parameters and chromosome instability, and a comparative study of DNA-RFLPs in cancer and constitutional tissue. The linkage study (to be reported elsewhere) confirmed the recently reported close linkage between the polyposis gene locus APC and D5S71. No in vitro test for the presence of the APC gene has been confirmed or revealed, but we detected increased chromosomal instability on a statistical basis and also recorded abnormal DNA-repair. As per 1. January 1988 the prevalence of adenomatosis of colon and rectum in Norway was 1/43,500. Among patients born in the period 1931-1950 the incidence at birth of developing the disease is 1/20,000 and the mutation rate is 1/72,000 per gamete per generation. In Norway new mutants in healthy families will comprise 1/3-1/2 of all new cases in the coming two decades, or one of 36,000 births.

In distal pancreatectomy, splenectomy has usually been an expedient component. In view of the recognized risk of overwhelming postsplenectomy septicaemia the current trend is splenic salvage whenever possible, in trauma surgery as well as in elective surgery. In order to emphasise this point we report a case of distal pancreatectomy with splenic salvage.