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This article discusses the use of oral antibiotics (OAB) and mechanical bowel preparation (MBP) in elective colorectal resections to reduce the risk of surgical site infections (SSI) and anastomotic leaks (AL). The article highlights the varying international recommendations for OAB and MBP, with some guidelines recommending against their use while others recommend routine use. The article also presents emerging data that supports the protective role of OAB and MBP in reducing SSI and AL. Despite local guidelines in Australia and New Zealand, a questionnaire study revealed a discrepancy between surgeons' preferences and current practice. The article emphasizes the need for a large-scale randomized control trial, called the CABE trial, to investigate the role of OAB with or without MBP in preventing AL and SSI in the Australasian population. The trial aims to recruit 4000 patients and may help update current protocols. [Extracted from the article]

Background: Limb salvage surgery (LSS) is now considered the gold standard surgical treatment for lower limb bone sarcomas. However, there is a paucity of literature comparing the various LSS reconstructive options. The aim of this systematic review and meta‐analysis was to compare functional outcomes and complications of LSS reconstructive techniques. Methods: The primary aim of the meta‐analysis was to determine functional outcomes from the pooled data utilizing the Musculoskeletal Tumour Society score (MSTS). Comparisons could then made for this outcome between biological and prosthetic, vascularised and non‐vascularised, and prosthetic and composite reconstructions. The secondary aim was to compare complication outcomes of each reconstruction. Standardized mean difference (Cohen's d) and odds ratios were estimated using a random effects model. Results: Fourteen studies with a total of 785 patients were included. We found structural failure was 75% less likely to occur in prosthetic reconstruction compared to biological (OR = 0.24; 95% CI: 0.07–0.79; P = 0.02). We did not find any evidence of difference in function (MSTS score) between vascularised verses non‐vascularised reconstructions (Cohen's d = −1.14; 95% CI = −3.06 to 0.78; I2 = 87%). Other analyses comparing complications found no difference between the reconstructive groups. Conclusion: The study found no correlation between functional outcomes and the type of LSS reconstruction. Structural failure was more likely to occur in biological when compared with prosthetic reconstruction. There was no correlation between the incidence of other complications and the type of LSS technique. This suggests a role for improved approaches to reconstruction methods including bioprinting and bioresorbable devices. [ABSTRACT FROM AUTHOR]

Objectives: Right hemicolectomy is a common colorectal operation for resection of cancers of the right colon. The ileocolic anastomosis may be created using a stapled end‐to‐side, stapled side‐to‐side or handsewn technique. Anastomotic leak and post‐operative bleeding are uncommon but serious causes of morbidity and mortality, while post‐operative ileus contributes to prolonged length of stay. The aim of this study was to evaluate differences in short‐term outcomes between different anastomotic configurations following right hemicolectomy for colon cancer. Methods: We conducted a retrospective study using data from the Bowel Cancer Outcomes Registry (BCOR), including 94 hospitals across Australia and New Zealand, of all patients who underwent right hemicolectomy or extended right hemicolectomy for colon cancer with formation of a primary anastomosis between 2007 and 2021. Results: We included 8164 patients in the analysis. There was no significant difference in rates of anastomotic leak and anastomotic bleeding based on anastomotic technique. A stapled end‐to‐side anastomosis was associated with a lower rate of post‐operative ileus than stapled side‐to‐side anastomosis (6.5% vs. 7.2%; P = 0.03). Conclusion: Both handsewn and stapled anastomosis techniques may be utilized for oncologic right hemicolectomy, with comparable rates of anastomotic leak and post‐operative bleeding. Stapled end‐to‐side anastomosis resulted in lower rates of prolonged ileus compared to stapled side‐to‐side anastomoses. [ABSTRACT FROM AUTHOR]

Backgrounds: Surgical site infections (SSI) are a significant cause of postoperative morbidity and mortality, contributing to a considerable financial burden on the healthcare system. Insufflation of the open surgical wound with warm, humidified carbon dioxide (CO2) is a novel measure aimed to reduce SSI. The local atmosphere of warm, humidified CO2 within the open surgical wound is proposed to decrease airborne contamination, bacterial growth, desiccation, and heat loss while improving tissue oxygenation and perfusion. This randomized controlled trial evaluates the impact of the HumiGard™ surgical humidification system on the incidence of SSI in patients undergoing open colorectal surgery. Methods: We conducted a multi‐site single‐blinded randomized control trial on patients undergoing elective or emergency laparotomy at a single tertiary Colorectal Surgery service. The primary outcome measure was the incidence of SSI, with secondary outcomes including ICU length of stay (LOS), total LOS and mean core temperature. Results: Patients who received HumiGard™ had a lower incidence of SSI, although this did not reach statistical significance (4.5% for treatment group versus 13.0% for control group; P = 0.092). There was no significant difference in ICU LOS or total LOS between cohorts. The HumiGard™ group had a higher mean core temperature than the control at the end of surgery (P < 0.001). Conclusion: The present study could not confirm that utilization of warm, humidified CO2 with HumiGard™ reduces SSI in open colorectal surgery. Further research is indicated to validate and extend these findings. [ABSTRACT FROM AUTHOR]

Background: There is a rising incidence in young-onset colorectal cancer, with these patients falling outside of routine screening programmes. The aim of the study is to characterize the nature of altered bowel habits in young patients who are diagnosed with colorectal cancer. Methods: A retrospective audit was conducted of adult patients younger than 45 years admitted under a Colorectal Surgery unit (Dandenong Hospital, Victoria) from 2011 to 2019 for the resection of colorectal cancer. We compared the patients’ self-characterization of their bowel habits (from the medical record) with clinical and pathological data. Results: A total of 75 patients were identified, aged between 18 and 45 years, who had surgical resection of colonic or rectal adenocarcinoma between 2011 and 2019. Forty-two (56%) presented with altered bowel habit (irregular bowel habit n = 13, 17%; constipation n = 13, 17%; diarrhoea n = 23, 31%). Constipation approached significance in association with left-sided colonic cancer. Fatigue approached significance in association with right-sided colonic cancers, which were less likely to present with bleeding or constipation, and approached significance in being less likely to present with diarrhoea. Rectal cancers were more likely to present with bleeding. Conclusion: Constipation was associated with left-sided colonic cancers, while right-sided colonic cancers were less likely to present with either constipation or diarrhoea. Our findings reinforce the need for clinicians to consider colorectal cancer as a differential diagnosis in young patients with altered bowel habits, or in patients with fatigue in the absence of specific bowel symptoms. Further prospective research is needed to further define bowel habits in this cohort. [ABSTRACT FROM AUTHOR]

Bleeding related to rectal varices associated with portal hypertension is rare but life‐threatening, and requires prompt treatment. We reviewed the literature for patients with this complex presentation and current recommendations, and commented on a case at our institution of a 68‐year‐old man with Child‐Pugh B alcoholic liver cirrhosis and hepatic encephalopathy who presented with profuse life‐threatening rectal variceal bleeding. Treatment options for rectal varices in patients with hepatic encephalopathy were reviewed and a management algorithm was devised from current knowledge in the literature. We suggest endoscopic management, and if unsuccessful then to proceed to angioembolization and/or balloon‐occluded retrograde transvenous obliteration, which may be used in conjunction with surgical management. The chosen therapeutic option may depend on the clinical condition of the patient, the cause of portal hypertension and clinical expertise or facilities available. Given that transjugular intra‐hepatic portosystemic shunting is contraindicated in patients with hepatic encephalopathy, management of life‐threatening rectal variceal bleeding should be multimodal. [ABSTRACT FROM AUTHOR]

GLO:HWR/01jun21:ans16381-fig-0001.jpg PHOTO (COLOR): 1 Computed tomography pelvis (axial) para-rectal nodule. gl GLO:HWR/01jun21:ans16381-fig-0002.jpg PHOTO (COLOR): 2 Magnetic resonance imaging pelvis (axial) para-rectal nodule. gl Intraoperatively, the gallstone was found embedded into the friable mesorectum forming a cavity. Laparoscopic cholecystectomy has become the gold standard in treating symptomatic gallstones or cholecystitis. Perforation of gallbladder and spillage of gallstones during the procedure are not uncommon, with a reported incidence of 6-40%.1,2 Unretrieved gallstones have been reported in 1-40% of cases after laparoscopic cholecystectomy and it rarely causes complications.1-3 However, complications that occur from retained gallstones include simple abscesses, fistula and rarely small bowel obstruction.4-6 As such, it is important that all gallstones be retrieved when possible. [Extracted from the article]

Background Free tissue reconstruction is reliable in suitable patients but patient selection remains a challenge for the reconstructive surgeon. The anterolateral thigh (ALT) free flap and pedicled pectoralis major myocutaneous flap (PMMF) are two common reconstructive options for a lateral temporal bone resection defect. The threshold at which free tissue reconstruction should be considered over locoregional reconstruction is not defined. We sought to define reconstructive flap choice in the setting of medical comorbidities that may dissuade free tissue transfer. Methods: A retrospective analysis of lateral temporal bone defects at a single institution was undertaken. The primary outcomes were flap survival, surgical complications and durations of surgery and stay. Data regarding medical comorbidities and potential confounders were examined. Results: Sixty patients with lateral temporal bone defects were identified. Twenty‐four (40%) patients underwent PMMF reconstruction and 36 (60%) were reconstructed with ALT. The former were significantly older (73 versus 62 years), though with similar Anesthesiologists Risk Classification System status. Free‐flap reconstruction resulted in significantly less flap loss (two versus six) but a longer operating time (790 versus 671 min). Conclusion: Patients suffering head and neck cancer with medical comorbidities can make selection of a suitable reconstruction difficult. We found that while patients undergoing ALT reconstruction were typically younger, the comorbidity profile of those patients was similar to patients undergoing PMMF reconstruction. ALT flaps were more reliable than the PMMF, lending credence to the view that free tissue transfer should be the preferred reconstructive option in suitable candidates and defects. [ABSTRACT FROM AUTHOR]

A 59-year-old female initially presented to the emergency department (ED) with anorectal pain and per rectal (PR) blood loss after self-administration of a water enema on a daily basis over the preceding 4 days as part of a weight loss programme. (c) Abscess cavity with rectal contrast observed to not extravasate into cavity. gl Intraoperatively, bimanual examination raised the suspicion for a low rectal perforation with fluctuance on the anterior rectal wall. 6 Kalkan IH, Oztas E, Yildiz H, Beyazit Y, Suvak B, Boyabatli M. Rectal perforation as a result of self-administration of retrograde enema in an elderly dementia patient. [Extracted from the article]

Anorectal traumas are uncommon and are usually associated with penetrating traumas.1 It is an unusual occurrence to sustain an anorectal injury secondary to blunt trauma.1This is due to the anatomical protection offered by the pelvis.2 Only 5%-10% of rectal injuries are secondary to blunt traumas, with 1%-2% associated with a pelvic fracture.3 Rectal injuries are classified according to anatomical location and severity.4 The anatomical location is defined as either "intra-peritoneal" or "extra-peritoneal".2,4 The severity is classified using the rectal injury scale from the American Association for the Surgery of Trauma.2,4 Management of rectal injuries is complex and often controversial. A 55-year-old lady presented to her nearest hospital with significant blunt anorectal trauma after a fall from a horse. J Trauma Inj. 2017; 30: 216 - 9. 6 Navsaria PH, Graham R, Nicol A. A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy. [Extracted from the article]

Repeat cross-sectional imaging in the form of abdominal computed tomography with oral contrast demonstrated acute gastric outlet obstruction secondary to the distal stomach being present in the parastomal hernia defect (Fig.). References 1 Eastment J, Burstow M. Parastomal stomach herniation complicated by gastric outlet obstruction: a case report and literature review. [Extracted from the article]

The article discusses the potential use of dexamethasone as a non-operative alternative in managing adhesional small bowel obstruction (ASBO). While Gastrograffin (GG) is currently a common non-operative treatment, recent disruptions in its supply chain have prompted the exploration of alternatives like dexamethasone. The article suggests that further research is needed to determine the efficacy, safety, and optimal dosing of dexamethasone in ASBO management, highlighting the potential for improved patient outcomes with this alternative treatment approach. [Extracted from the article]