Surgery for colonic obstruction were studied. Patients with an obstructive lesion distal to the splenic flexure were assessed as having a distal colonic obstruction. Resection and primary anastomosis was the operation of choice in selected patients. Alternative procedures were Hartmann's procedure in high-risk patients, subtotal colectomy in cases of associated proximal colonic damage, and colostomy or intestinal bypass in the presence of irresectable lesions. Obstruction was considered proximal when the tumor was situated at the splenic flexure or proximally and a right or extended right colectomy was performed. A range of factors were investigated to estimate the probability of death: gender, age, American Society of Anesthesiologists score, nature of obstruction (benignvs. malign), location of the lesion (proximalvs. distal), associated proximal colonic damage and/or peritonitis, preoperative transfusion, preoperative renal failure, and laboratory data (hematocrit ≤30 percent, hemoglobin ≤10 g/dl, and leukocyte count >15,000/mm3). Univariate and multivariate forward steptwise logistic regression analysis was used to study the prognostic value of each significant variable in terms of mortality. RESULTS: One or more complications were detected in 109 patients (46.5 percent). Death occurred in 44 patients (18.8 percent). No differences were observed between proximal and distal obstruction. Age (>70 years), American Society of Anesthesiologists III-IV score, preoperative renal failure, and the presence of proximal colon damage with or without peritonitis were significantly associated with postoperative mortality in the univariate analysis. Only American Society of Anesthesiologists score, presence of proximal colon damage, and preoperative renal failure were significant predictors of outcome in multivariate logistic regression. CONCLUSION: Large bowel obstruction still has a high of mortality rate. An accurate preoperative evaluation of severity factors might allow stratification of patients in terms of their mortality risk and help in the decision-making process for treatment. Such an evaluation would also enable better comparison between studies performed by different authors. Principles and stratification similar to those of distal lesions should be considered in patients with proximal colonic obstruction. Reprints are not available. aColorectal Unit, Department of Surgery, Hospital Universitario de Bellvitge, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain, e-mail: sbiondo@csub.scs.es © The ASCRS 2004...

Objective  Sacral nerve stimulation (SNS) is an established treatment for faecal incontinence. We aimed to identify specific factors that could predict the outcome of temporary and permanent stimulation.Method  A cohort analysis was performed to identify potential predictive factors in 81 patients who underwent temporary SNS at a single institution over a 10‐year period (June 1996 to June 2006). Data were obtained from prospectively collected patient symptom diaries and quality of life questionnaires, operation reports, anorectal physiological studies, endoanal ultrasound images and radiology of lead placement.Results  Clinical outcome of temporary screening was not affected by patient gender, age, body mass index, severity or length of symptoms. The need for a repeated temporary procedure was associated with subsequent failure during screening (P = 0.008). A low threshold to obtain a motor response during temporary lead insertion was associated with improved outcome (P = 0.048). Evidence of anal sphincter trauma was associated with a greater risk of failure (P = 0.040). However, there was no difference in medium‐term outcome between patients with external anal sphincter (EAS) defects and patients with intact anal sphincter muscles.Conclusion  Variables have been identified that help to predict the outcome of SNS. The presence of an EAS defect should not preclude treatment.

Background: There is ongoing controversy concerning the virulence and management of diverticulitis in young patients. This study reports on the management of acute diverticulitis with reference to the virulence and outcome of the disease with respect to age. Methods: Between January 1994 and June 1999, 327 patients were treated for acute left colonic diverticulitis. Patients were divided in two groups: those aged 50 years or less (group 1, 72 patients) and those older than 50 years (group 2, 255 patients). The diagnosis was confirmed histologically or radiologically in all patients. Results: There were differences in gender distribution related to age (P < 0·001). During the first hospital stay, 226 patients (69·1 per cent) had successful conservative treatment, 78 (23·9 per cent) needed emergency surgery and 23 (7·0 per cent) had a semielective operation (P = 0·47). The recurrence rate was 25·5 per cent in group 1 and 22·3 per cent in group 2 (P = 0·93). The type of surgical procedure and grade of peritonitis in emergency patients were similar in the two groups. Overall the mortality rate in patients who underwent an operation was 16·3 per cent. The mortality rate was zero in group 1 and 2·2 per cent in group 2 after elective or semielective operation (P = 1·0), and zero in group 1 and 34·9 per cent in group 2 after emergency operation (P < 0·001). Conclusion: Diverticulitis in young patients does not have a particularly aggressive course and the risk of recurrence is similar to that of older patients.