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Teaching technical skills is one of the most crucial tasks of the academic surgeon. The 10-year experience with a psychomotor skills laboratory at the Department of Surgery of the Université de Montréal is reported. Since 1983, first-year trainees were freed of hospital duties for "a week of surgical techniques" to develop their basic surgical technique and perioperative skills. Cognitive and practical sessions were designed for two groups of 10 residents. Teaching videos, suture boards, biologic substitutes, animal laboratory, round table discussions and formal lectures were the techniques used. Cognitive sessions were designed to provide information on instrumentation, adequate preoperative preparation, general organization of the operating room, intensive care and endoscopy units. The surgical procedures were approved by the local animal ethics committee. The program helped residents achieve surgical dexterity in a less stressful and more controlled manner than in the operating room. Close relationships of the trainees with their peers and teachers were established early helped to improve the operating environment. This program helps junior residents understand the complex world of the operating room and reduces the operative risks related to technique.

The authors report the case of a 52-year-old man who had stenosis and necrosis of the right colon secondary to acute pancreatitis. The right colon is a very uncommon location for this complication. The site of the stenosis was documented by contrast enema examination and computed tomography. Although conservative management is usually advocated for the initial management of this complication, laparotomy was necessary when the patient's condition failed to improve with conservative therapy. Colonic necrosis was found at laparotomy, and a partial colectomy was carried out, followed later by ileocolic reanastomosis. The authors emphasize the diagnostic and treatment options for this entity.

Dietary habits of patients who had undergone ileal pouch-anal anastomosis were assessed and correlated with bowel function. Twenty-four well-adapted patients (11 women, 13 men; mean age 32 years) voluntarily entered the study 30 +/- 4 months after closure of the diverting ileostomy. A standardized questionnaire on 108 food items and a 3-day food journal were used in the assessment. Twenty-one patients had no difficulty in selecting an appropriate diet. Caloric intake was adequate. Specific symptoms associated with several foods were as follows: increased stool frequency (beer, spirits, chinese food), decreased stool consistency (beer, wine, fried fish), perianal irritation (spicy foods), undigested particles (grapefruit, lettuce), odours (eggs). Pasta and bananas were associated with increased stool consistency. The authors believe that these observations may help in dietary counselling after ileal pouch-anal anastomosis.

The aim of this study was to determine whether anorectal manometry could predict clinical outcome after closure of a diverting ileostomy made at the time of colectomy, mucosal proctectomy and endorectal ileoanal anastomosis for chronic ulcerative colitis. Twenty-two patients were studied, 6 with ileoanal anastomosis and 16 with ileal pouch-anal anastomosis. Resting anal sphincter pressures and pressure-volume curves (compliance) of the neorectum were assessed before the diverting ileostomy was closed and results were correlated with frequency and leakage of stools 1 month after closure. Before stomal closure, the mean (+/- standard error of the mean) resting sphincteric pressure was 44 +/- 5 cm H2O, while neorectal compliance was 2.3 +/- 0.3 ml/cm H2O. One month later daily stool frequency was 12 +/- 1, while severe leakage occurred in four patients during the day and in eight at night. The greater the sphincteric pressure and the compliance, the fewer were the number of stools per day (p less than 0.01). When pressure and compliance were considered together as an index of anorectal function, the correlation of stool frequency and leakage was even stronger (p less than 0.001). The authors conclude that anorectal manometry can predict early clinical outcome after ileoanal anastomosis.

The author reviews some aspects of fecal continence after ileoanal anastomosis with an ileal reservoir. Also, the consequences of fecal stasis on small-bowel absorption and morphologic and bacteriologic features are discussed. Some recommendations for the follow-up of these patients are outlined.