Changing Trends in Surgery of the Colon

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The preoperative preparation of the bowel with sulfonamides and antibiotics, the prophylactic use of antibiotics after operation, and modern advances in surgical technic have contribued materially to the safety of operations on the colon. As a result of these advances it is possible today to perform with relative safety operations which prior to 1940 were deemed hazardous; to preserve the rectal sphincter when formerly it was often necessary to sacrifice it, and to perform primary end-to-end anastomoses in situations which at one time appeared to demand obstructive resections or complementary colostomies with their attendant inconvenience and morbidity. The purpose of this study is to evaluate the present status of the various types of operations in colon surgery.

Changes in Preparation of Colon

Prior to 1942 patients to be subjected to resections of the colon were prepared by the use of magnesium sulfate and a low residue diet. Occasionally sulfonamides were given after operation, but these were used therapeutically in the treatment of established complications and not prophylactically.

Since the war (1946) we have prepared the bowel by administration of sulfasuxidine given in doses of 3 Gm. four times daily for 7 days before operation and sometimes supplemented by streptomycin, 1 Gm. given twice daily for the last 2 days. More recently aureomycin has been used in doses of 500 to 750 mg. four times daily for 3 days. The latter is not only the most effective means of reducing the bacterial count in the stool,1 but is also absorbed and. . .



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