Enhanced recovery after anterior resection: earlier leak diagnosis and low mortality in a case series.

Introduction: Early detection and treatment of anastomotic leak may mitigate its consequences. Within an enhanced recovery setting, the subtle signs of a leak can be more apparent. There are multiple treatment options for anastomotic leak following anterior resection.

Outcome of surgery for recurrent anal cancer: results from a tertiary referral centre.

Aim: Chemoradiotherapy remains the first line of treatment for anal cancer with surgery reserved for cancer recurrence or persistence. The low incidence of anal cancer means that the numbers undergoing surgery is small with centralization for excision to regional cancer centres. We present our experience of abdominal perineal excision, with reconstruction of the perineal defect (APERR), within a tertiary centre.

Ileostomy closure in an enhanced recovery setting.

Aim: Hospital stays of 5 days or more are not uncommon following ileostomy closure, yet within an enhanced recovery programme (ERP) it is possible for patients to be discharged on the first postoperative day following anterior resection. The aim of this study was to evaluate whether the introduction of an ERP for ileostomy closure reduced hospital stay without affecting morbidity or readmission rates.

Method: Consecutive patients undergoing elective ileostomy closure from October 2000 to March 2013 were included in this study.

The English national low rectal cancer development programme: key messages and future perspectives.

Aim: Adenocarcinoma of the lower rectum is clinically challenging because of the need to choose between a wide excision to achieve oncological clearance, on the one hand, and sphincter conservation to maintain anal function, on the other. The English National Low Rectal Cancer Development Programme (LOREC) was developed under the auspices of the Association of Coloproctology of Great Britain and Ireland and the English National Cancer Action Team to improve the outcome of low rectal cancer in England.

Method: LOREC was initiated focusing on preoperative imaging, selective neoadjuvant therapy, optimal surgical treatment and detailed pathological assessment of the excised specimen.

Vertical rectus abdominis myocutaneous flap reconstruction of the perineal defect after abdominoperineal excision is associated with low morbidity.

Aim: To examine the short-term outcomes of perineal reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap following abdominoperineal excision (APE).

Method: Retrospective case note review of all patients undergoing APE and primary VRAM reconstruction between July 2001 and February 2012 in a district general hospital tertiary referral centre for APE. Complications were categorized using the Clavien-Dindo classification, which grades complications from I to V in order of increasing severity.