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Endoscopic decompression of the distended colon has become a useful method of treating non-obstructive colonic ileus. We propose a method of establishing a cecal fistula by means of percutaneous puncture of the colon and pull-through of a Pezzer catheter. Although until now we have only performed this procedure twice, it seems to be a valuable therapeutic approach in cases of paralytic distension of the large bowel.

Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.

Some modifications to the technique of Longmire-Mouchet after total gastrectomy are proposed. They permit a more rapid and safe surgical treatment.

During the last decades several types of surgical techniques have been utilized in order to provide the patient with a continent colostomy using the colon as a reservoir. None of the methods have gained wide acceptance and continence is usually dependent upon successful irrigation. By constructing a cecal reservoir with an intussuscepted nipple valve, using the same principle as for the continent ileostomy, a colostomy with perfect continence for both gas and feces can be created. Although improving life quality significantly when successful, the method is hampered by a high rate of complications and malfunction. So far none of the methods introduced offer any great advantage to conventional sigmoidostomy with irrigation. There is, however, evidence that the functional results after coloanal anastomosis may be improved by constructing a pouch-anal anastomosis. The clinical significance of this technical modification is not yet fully evaluated.

The relapse of icterus may be a sign of serious postoperative complication after hepatic portoenterostomy for biliary atresia. To analyse the cause of such icteric flare-up, a retrospective study was made on 27 patients. A total of 38 episodes of icteric flare-up occurred in 19 patients. An accompanying disease, which had not directly involved the biliary tract, was assumed to be the cause in 11 episodes (29%). Fourteen episodes (37%) were due to biliary tract infection caused by the cyst formed at the porta hepatis (5 episodes) or so-called ascending cholangitis (9 episodes). The other 13 episodes (34%) were free from both accompanying disease and signs of biliary infection. Among them, the cause of icteric flare-up was the cyst at the porta hepatis in one episode, scar tissue formation at the porta hepatis in 9 episodes and undetermined in 3 episodes.

Two kinds of intestinal sutures performed with the use of a precision technique were investigated on models of acute intestinal obstruction. One-row (serous-muscular-submucosal) and two-row (serous-musculo-submucosal and submucosal-mucosal) sutures provide an exact layer-after-layer connection of the intestinal wall layers and a sufficient mechanical firmness of the anastomosis with little traumatization. The dynamics of microcirculation changes in the anastomosis zone was followed with the help of contact intraoperative biomicroscopy. Symptoms of the traumatic inflammation were cupped off within 5 days and changed by reparative processes.

The postoperative care of stoma patients is truly life long. With the excellent stoma equipment available, no patient should be a "stoma cripple." New advances in continent reservoirs will improve patient acceptance and lessen the fear associated with stomas. Finally, close follow-up by both the enterostomal therapy nurse and the surgeon is essential for the complete care of the stoma patient.