Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience.

Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas.

Pathophysiological basis, clinical assessment, investigation and management of patients with obstruction defecation syndrome.

Obstructed defecation syndrome (ODS) is a clinical syndrome manifest as difficulty in faecal evacuation despite no mechanical obstruction. It is the final clinical pathway of a number of anatomical and physiological pathologies they can result in considerable misery to the lives of the patients it afflicts. Herein, the authors seek to breakdown the syndrome into its component parts, looking first at normal pelvic floor anatomy and physiology; followed by each pathological element; clinical features and investigation; individual management and management of the patient as a whole.

Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right-Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?

Purpose and research question Cross-sectional imaging with CT scanning is the most commonly performed imaging modality to stage right-sided colon cancers. There is increasing evidence for the use of neo-adjuvant chemotherapy in selected patients and debate about the role of complete mesocolic excision (CME) and central vascular ligation (CVL) in the management of locally advanced colon cancers. Predicted tumour stage and the presence of nodal metastases by CT are often used to select patients for neo-adjuvant chemotherapy and those that may benefit from CME.

Anatomy of the Mesentery.

It is clear that despite the importance of multimodal therapy, the most impactful weapon in the arsenal of treatment in a patient with colorectal cancer is high-quality surgery. This has been shown time and time again and surgery remains the bedrock in the management of visceral, and particularly colorectal, cancer. The reason for this is an anatomical one, based upon embryological planes.

Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study.

Background: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients.

Resectional surgery for malignant disease of abdominal digestive organs is not surgery of the organ itself, but also that of the mesenteric organ.

Despite large strides in molecular oncology, surgery remains the bedrock in the management of visceral cancer. The primacy of surgery cannot be understated and a mesenteric (i.e.

Complications - A surgeon's perspective and humanities' methods for personally dealing with them: The "4 R's".

Herein the author includes his philosophical take on how surgeons' deal with complications. He explains how often Mortality and Morbidity meetings miss a fundamental point of how the surgeon him/herself deals with complications. The author proposes a classification of the 4 commonest coping strategies used by mankind to deal with the doubt and uncertainty that a career in surgery, a real marathon, entails.

Surgery in the older person: Training needs for the provision of multidisciplinary care.

Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population.

Circulating levels of anti-angiogenic VEGF-A isoform (VEGF-Axxxb) in colorectal cancer patients predicts tumour VEGF-A ratios.

Purpose: Bevacizumab as an adjunct to chemotherapy improves survival for some patients with metastatic colorectal cancer. Immunohistochemical staining of samples from the registration ECOG E3200 trial of bevacizumab with FOLFOX demonstrated that only patients with carcinomas expressing low levels of VEGF-A165b, an anti-angiogenic splice variant of the Vascular Endothelial Growth Factor family of proteins, benefited from bevacizumab treatment. To identify a more useful biomarker of response we tested the hypothesis that circulating VEGF-A165b levels correlate with immunohistochemical staining.

Female gender and diabetes mellitus increase the risk of recurrence after laparoscopic incisional hernia repair.

Background: Laparoscopic hernia repair is used widely for the repair of incisional hernias. Few case studies have focussed on purely 'incisional' hernias. This multicentre series represents a collaborative effort and employed statistical analyses to provide insight into the factors predisposing to recurrence of incisional hernia after laparoscopic repair.

Multidisciplinary perspective on the management of appendiceal adenocarcinoma: case review of 10 patients from a university hospital and current considerations.

Background: Adenocarcinoma of the vermiform appendix is rare. It constitutes less than 0.5% of all gastrointestinal malignancies.

Perforated jejunal ulcer associated with gastric mucosa in a jejunal diverticulum.

Jejunal diverticula are rare and subsequent complications even more so. The usual small bowel diverticulum encountered by general surgeons is a Meckel's. These are embryological remnants of the vitello-intestinal duct and are on the anti-mesenteric surface of the terminal ileum.

Hydrocele of the canal of Nuck--an old problem revisited.

Herein the authors describe the case of a young woman presenting with a tender lump in her groin. Clinically the differential was of either a reactive lymph node or a femoral hernia. Ultrasound scan was urgently arranged and showed a cystic lesion.

Abdominal compartment syndrome caused by tension pneumoperitoneum in a scuba diver.

Abdominal compartment syndrome is a surgical emergency caused by a raised intra-abdominal pressure, which may lead to respiratory, cardiovascular and renal compromise. It is most commonly seen in post-operative and trauma patients and it has a variety of causes. Tension pneumoperitoneum (TP) is a rare cause of abdominal compartment syndrome most often seen after gastrointestinal endoscopy with perforation.

Caution: laparoscopic biopsy of a large pelvic mass may result in disaster.

Anterior sacral meningocele is a rare cause of a pelvic mass. Herein the authors describe the case of a young patient presenting with chronic pelvic pain undergoing diagnostic laparoscopy. She was found to have a retrorectal mass confirmed as an anterior sacral meningocele on subsequent MRI.

A retrospective wound review of standard four-port laparoscopic cholecystectomy: is there need for single-port laparoscopic surgery?

Background: This study was designed to assess the satisfaction or otherwise of a proportion of the U.K. population who have undergone standard four-port laparoscopic cholecystectomy within the past 18 months.

Pouch of Douglas pelvic hernia: a rare entity managed laparoscopically.

Pouch of Douglas hernias are uncommon forms of pelvic hernia. They are most commonly seen in multiparous, elderly women and those having undergone previous pelvic surgery (Stamatiou et al. in Am Surg 76(5):474-479, 2010).