Correspondence

These four patients were included in the analysis. The 54 patients in the ‘drain’ group had a median age of 56.5 years (range 19-76) and the 87 in the ‘no drain’ group had a median age of 52 years (range 16-84). This difference was significant (U = 1746, P=0.04) . All elective, urgent and emergency operations were included.

One patient died as a consequence of pre-existing disease. The postoperative hospital stay actually fell from a median of 5 days

(range 3-12) to 4 days (range 2 4 5 ) (U=1601, P=O.O2). When drainage was used there were complications in six cases

(jaundice due to Omnopon@ (Roche Products Ltd., UK) infusion (l) , cellulitis (l), bile leak after common bile duct puncture cholangiogram (l) , urinary infection (2) and chest infection (1)).

In the cholecystectomies without drainage, there were 5 complications (unexplained hypotensive episode (l), wound bruising associated with heparin use (l), urinary retention (2) and pyrexia of unknown origin (1)). In particular we have not seen any subhepatic or subphrenic collections although routine scanning has not been used.

Our results clearly show that routine drainage after cholecystectomy is unnecessary and may possibly contribute to a longer hospital stay.

J. Beynon A. P. Corfield

M. H. Thompson Southmead Hospital Bristol BSlU 5 M B V K

Operative treatment of median cervical cysts Sir We read with interest the paper by Tetteroo et ai. (Br J Surg 1988; 75: 382-3) which reemphasizes the importance of removing the central portion of the hyoid bone in the surgical management of thyroglossal duct remnants.

Our own experience of 35 patients operated on for this pathology during the period 1983-87 is very similar. There were 18 women and 17 men with an age rangeof 1-71 years. All these patients had a history of a lumpat orcloseto themidlineoftheneck, but theduration ofsymptoms ranged from only a few days to 20years. We had eight cases of recurrent disease (23 per cent). Six of these patients had neither excision of the body of the hyoid bone nor tongue base dissection at the primary operation and, although in the other two the hyoid had been removed, no dissection of the thyroglossal tract to the foramen caecum had been attempted.

In his classical paper in 1920, Sistrunk suggested that surgical treatment of thyroglossal duct remnants should include excision of the body of the hyoid bone and the soft tissues extending to the foramen caecum1. This method was based on sound embryological principle as the thyroglossal tract passes through the centre of the second branchial arch which elaborates the hyoid bone. Seventy years later recurrent disease is still encountered when this simple principle is ignored by leaving the hyoid bone in situ.

M. L. Nicholson J. F. Sharp J. P. Diver

The Leicester Royal lnfirmary Leicester LE2 7LX U K

1. Sistrunk WE. The surgical treatment of cysts of the thyroglossal tract. Ann Surg 1920; 71: 1214.

Treatment of gastric varices Sir The paper by Sarin and his colleagues (Br J Surg 1988: 75; 747-50) advocates prophylactic injection of gastric varices. Their own results fail to justify such a policy.

Of their 309 patients undergoing sclerotherapy for varices, only 48 had gastric varices. In eight, gastric varices were considered to be the source of bleeding but in only five was bleeding observed and for at least two of these the cause was iatrogenic ulceration from previous injections. Thus, there was proven spontaneous gastric variceal bleeding in about 1 per cent of their patients.

They then took 32 patients who had never bled from gastric varices and entered them on a programme of injection sclerotherapy. Only 12 achieved obliteration and 11 died in the attempt. Eight of these deaths were due to uncontrolled bleeding from gastric varices which had never previously bled. This gives a mortality of 34 per cent for prophylactic injections compared to only 25 per cent in their eight patients who were actively bleeding from gastric varices.

Gastric varices, unlike oesophageal varices, are protected by the muscularis mucosa and to damage this layer and the overlying mucosa by injection sclerotherapy is foolhardy. Since gastric varices rarely bleed spontaneously, I counsel a policy of masterly inactivity for non-bleeding gastric varices.

G. W. Johnston Royal Victoria Hospital Belfast BT12 6BA U K

Wound healing properties of honey

Sir How delighted I am to read the paper by Mr S. E. E. Efem (Br J Surg 1988; 75: 679-81) concerning the wound healing properties of honey. I can only concur with his findings and I have been using this material myself for a number of years to clean up infected wounds, particularly around the face following trauma. Its use does seem to provoke hilarity amongst one’s colleagues until they have tried it. Apart from its efficacy I find it is particularly useful in that it is so easily removed by simple bathing, being of course water soluble, compared with many other preparations which are in a greasy base.

As regards its method of action, 1 agree with Mr Efem that hypertonicity is likely to be the answer and it has certainly served the fruit preserving industry well for many years! In this part of the country where honey seems to be a luxury, I can assure you that golden syrup seems to work just as well.

A. E. Green Burnley General Hospital Burnley Lancashire BBlU 2PQ V K

Sigmoidoscopy in the Indian bowel Sir, We read with interest the article by Mann et al. (Br J Surg 1988; 75: 425-7) on factors which determine a successful sigmoidoscopy. We were surprised by the high frequency of unsatisfactory procedures that they encountered in patients not previously prepared. That this is not a universal experience can be appreciated from our data.

We analysed retrospectively the records of the last 124 patients (84 males, 40 females; aged 1&77 years, mean 38 years) on whom we undertook the procedure on an outpatient basis. The procedure is usually performed between 09.00 hours and 11.00 hours, which is roughly about 2 4 h after the average Indian relieves himself. No preparatory diet or medication is advised. We use the knee-elbow position routinely since previous experience showed us that it was more convenient to the operator and so to the patient.

The bowel preparation was reported as fair (17 cases) or good (89) on a poor-fair-good scale in 85.5 per cent of cases. The ’scope could be passed to a distance of more than 20cm in 84.5 per cent (we excluded from analysis those in whom the procedure was abandoned earlier for reasons other than bowel preparation). We agree with the contention that it makes no difference who performs the procedure as long as a few months’ background training is available.

Obviously, it matters not who does it, but on whom. The Indian bowel comes prepared for the occasion.

P. Abraham S. J. Bhatia

D. H. Pipalia Department of Gastroenterology King Edward Memorial Hospital Bombay India

1278 Br. J. Surg.. Vol. 75, No. 12, December 1988