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A review of the development of surgical procedures for the treatment of carcinoma of the rectum is presented. There have been very few truly new techniques offered in recent years; instead many of the older methods have been revived. This brief review of some of the important contributions made in this field may be of interest to today's surgeons. This discussion will concern the various approaches including perineal, abdominoperineal, abdominal, sacral, abdominosacral, abdominoanal, and vaginal approaches and local resections.

A retrospective study of colostomy closures was prompted by recent reports detailing frequent postoperative complications. In a series of 125 intraperitoneal colostomy closures there was a low incidence of complications. There were no anastomotic breakdowns, fistulas, or deaths. We conclude that closure of a well healed colostomy is a safe operation, the success of which is determined by the careful technic with which it is performed.

The type of endorectal pull-through described by Black was evaluated as an alternative method of anastomosis in 11 anterior resections in which anastomosis from above was impossible. The method is attractive from the standpoint of function because it preserves the distal rectum and leaves the anus intact. Technical points important to success are complete mobilization of the descending colon to allow the distal descending colon to be used for the pull-through and prophylactic dilatation of the early stenosis, which is characteristic of this type of anastomosis.

When pallative cholecystoenterostomy is contemplated but the cystic duct is found to be occluded, anastomosis of the hepatic duct to the gallbladder in combination with cholecystoenterostomy is a satisfactory alternative to decompression of the heptic duct by jejunal anastomosis and may be easier to perform. Hepatocholecystostomy is also useful as a simple operative method for restoring continuity when jaundice recurs after cholecystoenterostomy done for cystic duct obstruction.

Total pancreatectomy for benign disease should be considered only in highly selected patients and then only after lesser surgical procedures have failed. At present, truncal vagotomy and adequate gastrectomy should be part of the operation to prevent marginal ulceration. A multitude of undesirable problems, many requiring reoperation, may arise postoperatively and can compromise an otherwise excellent outcome with regard to pain control.