Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients.

Background: Current evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh and myocutaneous flaps, for which long-term follow-up data is lacking. The aim of this study was to evaluate the long-term outcomes of biological mesh (Surgisis, Biodesign™) reconstruction following ELAPER.

Robotic colorectal surgery: previous laparoscopic colorectal experience is not essential.

A background in minimally invasive colorectal surgery (MICS) has been thought to be essential prior to robotic-assisted colorectal surgery (RACS). Our aim was to determine whether MICS is essential prior to starting RACS training based on results from our initial experience with RACS. Two surgeons from our centre received robotic training through the European Academy of Robotic Colorectal Surgery (EARCS).

Day-case closure of ileostomy: feasible, safe and efficient.

Aim: Over 5000 loop ileostomy closures were performed in the UK in 2013 with a median inpatient stay of 5 days. Previously we have successfully implemented a 23-h protocol for loop ileostomy closure which was modified for same-day discharge. We present our early experience of day-case loop ileostomy closure.

One-third of patients fail to return to work 1 year after surgery for colorectal cancer.

Background: Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function at 1 year after colorectal cancer surgery.

Outcomes after biological mesh reconstruction of the pelvic floor following extra-levator abdominoperineal excision of rectum (APER).

Background: Extra-levator abdominoperineal excision of the rectum (ELAPER) for low rectal cancer is used to avoid the adverse oncological outcomes of inadvertent perforation and a positive circumferential resection margin associated with the conventional APER technique. This wider excision creates a large defect requiring pelvic floor reconstruction, and there is still controversy regarding the best method of closure. The aim of this study is to present outcomes of biological mesh pelvic floor reconstruction following ELAPER.

Internal hernias: a brief review.

Hernias are very familiar to a core surgical trainee in the setting of clinics and the surgical assessment unit. By definition, a hernia is an abnormal protrusion of a viscus from one compartment to another. In clinic, they are visible lumps, exhibiting a cough reflex often with a well definable history making them readily identifiable.

Twenty-three-hour stay loop ileostomy closures: a pilot study.

Background: In UK in 2010-2011, 4,463 ileostomy closures were performed (35,442 bed days) with a median inpatient stay of 5 days (Hospital Episode Statistics data). This seems anomalous when there are reports of 23-h stay colectomies. We present our early experience of 23-h discharge for loop ileostomy closures.

The 'cut and push' technique: is it really safe?

Percutaneous endoscopic gastrostomy (PEG) feeding is routinely used as an endoscopic and effective method for providing enteral nutrition in those whose oral access has been diminished or lost. One technique for removal of the PEG is cutting the tube at the skin level and allowing the tube and internal flange to pass spontaneously. This is known as the 'cut and push' method.

Closure of loop ileostomy: potentially a daycase procedure?

Background: Four thousand four hundred and twenty-seven ileostomy closures were performed in the UK in 2008-2009, (35,432 bed days). None were recorded as being performed as a daycase procedure. Our aim is to evaluate the morbidity and mortality associated with this procedure and to investigate whether daycase surgery is feasible.

Biological mesh reconstruction of perineal wounds following enhanced abdominoperineal excision of rectum (APER).

Introduction: An abdominoperineal excision of rectum (APER) may be required for rectal tumours less than 6 cm from the anal verge. Recently, the cylindrical APER has been used to prevent the "surgical waist" and so decrease margin involvement. However, removal of the levators leaves a large defect.

Diagnostic yield and economic implications of endoscopic colonic biopsies in patients with chronic diarrhoea.

Aims: Random colonic biopsies are recommended to exclude microscopic colitis in patients with chronic diarrhoea especially when mucosa is macroscopically normal at endoscopy. This study aimed to assess the clinical outcome and economic impact of such a policy in an unselected group of patients with macroscopically normal mucosa.

Methods: All new patients undergoing colonoscopy for investigation of chronic diarrhoea between April and December 2009 were included.

Primary small bowel liposarcoma (atypical lipomatous tumour) with myogenic differentiation.

Primary small intestinal liposarcomas originating in the small bowel are uncommon with a generally poor prognosis due to the advanced stage at the time of diagnosis. We describe a case of primary small bowel dedifferentiated liposarcoma presenting as a solid mass in the right iliac fossa. The current case is unusual as the tumour seemingly originated from the bowel and the well-differentiated component was seen extensively infiltrating the bowel wall including the small bowel submucosa.

Terminal ileal Crohn's disease: conservative surgeon and aggressive physician?

Objective: The timing of surgery in Crohn's disease is a matter of continuing debate, in particular early surgery for patients presenting with apparent appendicitis found to have terminal ileal Crohn's. Our aim was to assess the current strategies of UK Consultant Coloproctologists and Gastroenterologists in managing terminal ileal Crohn's disease in acute and elective settings.

Method: A postal questionnaire survey was sent to 460 Consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and a very similar 'medical' questionnaire sent to 1043 Consultant British Society of Gastroenterology (BSG) members.

An unusual presentation of caecal diverticulitis.

Solitary caecal diverticulitis is a rare and often misdiagnosed cause of abdominal pain. A 63-year-old Caucasian woman was admitted with a 3-day history of left upper quadrant pain and constipation. Preoperative imaging identified a possible transverse colonic tumour.

Chylothorax.

During a high speed road traffic accident, a 26-year-old man suffered multiple fractures of his thoracic vertebrae and bilateral pneumothoraces. The day after admission and commencement of nasogastric feeding, milky fluid was noted in his right chest drain. Feeding was stopped and a contrast oesophogram and oesophagoscopy were performed, which were normal.

Clostridium difficile enteritis in a patient after total proctocolectomy.

Clostridium difficile infection is associated with antibiotic therapy and usually limited to the colonic mucosa. However, it is also a rare cause of enteritis, with only a few cases reported in the literature. In the present report, the case of a 30-year-old woman with Clostridium difficile enteritis who previously had a panproctocolectomy with end ileostomy for severe ulcerative colitis is described.

Large bowel obstruction due to sesame seed bezoar: a case report.

We report a case of a 79 year old man with a known benign anastomotic stricture presenting with large bowel obstruction. At laparotomy the obstruction was found to be caused by a large sesame seed bezoar. Seed bezoars are well known to cause impaction in the rectum but have never been previously reported to cause large bowel obstruction.

Chylothorax.

During a high-speed road traffic accident, a 26-year-old man suffered multiple fractures of his thoracic vertebrae and bilateral pneumothoraces. The day after admission and commencement of nasogastric feeding, milky fluid was noted in his right chest drain. Feeding was stopped and a contrast oesophogram and oesophagoscopy were performed, which were normal.

Appendicitis.

Introduction: Potential causes of appendicitis include faecoliths, lymphoid hyperplasia, and caecal carcinoma, all of which can lead to obstruction of the appendix lumen. The lifetime risk is approximately 7-9% in the USA, making appendicectomy the most common abdominal surgical emergency. Mortality from acute appendicitis is less than 0.

A prospective, randomized controlled trial comparing n-butyl cyanoacrylate tissue adhesive (LiquiBand) with sutures for skin closure after laparoscopic general surgical procedures.

The aim of this study was to compare the efficacy of n-butyl-cyanoacrylate tissue adhesive (Liquiband) with nonabsorbable monofilament sutures for laparoscopic port site closure. Adult patients having elective laparoscopic procedures were randomly allocated to wound closure with sutures or tissue adhesive. End points included skin closure time, wound dressing requirements, wound complications, and cosmesis, assessed at discharge, 4 to 6 weeks and 3 months.

Radiation induced MMP expression from rectal cancer is short lived but contributes to in vitro invasion.

Aims: Matrix metalloproteinase (MMP) activity is increased after radiation. The aims of this study were to assess the time course of this increase and its effects on malignant cell invasion.

Methods: Colorectal cancer (HCT 116, LoVo, C 170 HM 2, CaCO-2), fibroblast (46-BR.