[Surgery of rectal ampulla adenoma]

It is necessary to diagnose and excise the adenoma of the mucous of the large intestine as early as possible in order to prevent the development of rectal carcinoma. The surgery techniques (according to Kraske and Mason) applied by the authors make it possible. Over the period from 1983 to 1990 these techniques were carried out in 37 operations of rectal adenoma. The main symptom of the disease was the appearance of mucus and sometimes of blood in faeces. The following examinations were performed during the preoperative course: digital, rectoscopic, sigmoidoscopic; several biopsies of the lesion and its surrounding tissue were made. Histopathological diagnosis obtained preoperatively was confirmed postoperatively in 32 cases. Only in 5 patients preoperative findings did not coincide with the postoperative findings. In one case the final diagnosis was adenocarcinoma, and the preoperative finding was villous-uvular adenoma. In 4 cases the preoperative findings revealed the existence of tubulous-glandular tumour, while the final diagnosis showed the early invasive carcinoma. In later operations the rectal amputation was performed in 2 cases, and rectal anterion resection in 3 cases. The recidives appeared in 3 patients during the first year after the operation. Two of them were from the villous-uvular group, and one was from the gland-uvular group. During reintervention the rectal amputation was performed twice, and resection of rectosigma once. During the postoperative course 7 spontaneously disappeared fistulae reappeared. No incontinence. Postoperative electromyographic, laboratory and rectoscopic examinations of the patients were performed each third month, during the two following years. We used Kraske and Mason operative technique in the villous adenoma operations. These villous adenomas were 2-3.5 cm long and located in the middle of the upper third of rectal ampulla, while the upper verge did not cover more than 13 cm of dental line.