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The article features a set of abstracts of various research papers presented at the meeting of Royal Society of Medicine, London on November 23, 2003. Some of the papers presented are Sacral nerve stimulation (SNS) for faecal incontinence in the Great Britain; Fatigability of the external anal sphincter in faecal incontinence; Treatment of persistent perineal sinus with pedicled flap: experience of a single colorectal surgeon etc. SNS is safe effective in the medium to long term for treatment of faecal incontinence when conservative treatment has failed.

Aim: Colorectal cancer (CRC) is diagnosed in approximately 45 000 people annually in the UK, and it is estimated that Lynch syndrome (LS) accounts for 3.1% of these cases. In February 2017, National Institute for Health and Care Excellence (NICE guideline DG27 recommended universal testing of new cases of CRC for mismatch repair (MMR) status. The aim of this study was to implement universal testing for LS in CRC patients in a secondary care setting. Method: We prospectively collected data on consecutive newly diagnosed CRC patients at our centre from November 2016 to August 2018, including evidence of MMR status determined by immunohistochemistry. We recorded clinicopathological data including age at diagnosis, stage, tumour site, reported histological findings and MMR tumour status. Statistical analysis was performed using the chi‐square test and the two‐tailed t‐test for binary and continuous variables, respectively. Results: A cohort of 203 consecutive patients were diagnosed with CRC during this period. Universal MMR testing was performed for the 198 CRC patients in whom a diagnosis of adenocarcinoma was confirmed, with colonoscopic biopsy used as the source material in 68.6% of cases. Twenty‐three CRCs (11.6%) were MMR deficient (dMMR). Most dMMR CRCs (21/23) were early stage tumours (Dukes A or B, P = 0.002). In 39 Dukes B CRCs in patients under 70 years of age, the result of MMR testing influenced decision‐making about personalized treatment with 5‐fluorouracil based chemotherapy. Conclusion: Our results demonstrate that universal testing of all new cases of CRC for features suggestive of LS is feasible and effective in the UK. Our data also indicate the importance of genetic testing and personalized oncological care. [ABSTRACT FROM AUTHOR]

Aim Around one-third of patients with Crohn's disease are affected by Crohn's fistula-in-ano (p CD). It typically follows a chronic course and patients undergo long-term medical and surgical therapy. We set out to describe current surgical practice in the management of p CD in the UK. Method A survey of surgical management of pCD was designed by an expert group of colorectal surgeons and gastroenterologists. This assessed acute, elective, multidisciplinary and definitive surgical management. A pilot of the questionnaire was undertaken at the 2015 meeting of the Digestive Disease Federation. The survey was refined and distributed nationally through the trainee collaborative networks. Results National rollout obtained responses from 133 of 179 surgeons approached (response rate 74.3%). At first operation, 32% of surgeons would always consider drainage of sepsis and 31.1% would place a draining seton. At first elective operation, 66.6% would routinely insert of draining seton, and 84.4% would avoid cutting seton. An IBD multidisciplinary team was available to 87.6% of respondents, although only 25.1% routinely discussed pCD patients. Anti-tumour necrosis factor-alpha therapy was routinely considered by 64.2%, although 44.2% left medical management to gastroenterologists. Common definitive procedures were removal of the seton only (70.7%), fistulotomy (57.1%), advancement flap (38.9%), fistula plug (36.4%) and ligation of intersphincteric track ( LIFT) procedure (31.8%). Indications for diverting stoma or proctectomy were intractable sepsis, incontinence and poor quality of life. Conclusion This survey has demonstrated areas of common practice, but has also highlighted divergent practice including choices of definitive surgery and multimodal management. Practical guidelines are required to support colorectal surgeons in the UK. [ABSTRACT FROM AUTHOR]

The article focuses on the surgical developments for colorectal diseases in Great Britain and the U.S. The laparoscopic resection of advanced colorectal cancer had higher rates for successful operation. A study has revealed the adverse effects of endoscopy to the chronic abdominal pain (CAP) of children in Houston, Texas.

Aim The aim of this study is to audit our outcomes and experience of colonic stent insertion for malignant bowel obstruction. Method Retrospective audit of all stent insertions in a single district general hospital between August 2003 and December 2009. All patients had presented with acute bowel obstruction caused by malignant colorectal disease and details were collected prospectively and contemporaneously onto a database. Stent insertion was a combined endoscopic and fluoroscopic procedure involving a colorectal surgeon and consultant radiologist. Results Stenting was attempted on 62 occasions in 54 patients. The technical success rate was 86% and the clinical success rate 84%. The indications for stenting were for relief of acute bowel obstruction, palliation and as a bridge to surgery. There were complications in 14 cases (22.5%) including three perforations and one perioperative mortality. There were three cases of stent migration, six cases of re-stenosis and two stents became impacted with stool. There were no incidents of acute or delayed haemorrhage in any patients. Conclusion Our experience shows that stenting for obstructing colorectal cancer is a safe and effective method of alleviating acute and impending bowel obstruction and can be provided safely and effectively in a district general hospital. [ABSTRACT FROM AUTHOR]

Aim Currently in the UK the standard surgical practice for the management of perforated sigmoid diverticulitis is a Hartmann's procedure. There have been a number of recent publications on the use of laparoscopic peritoneal lavage for perforated sigmoid diverticulitis, as an alternative to the emergency Hartmann's procedure, with its associated morbidity and mortality. We aim to review the current literature on this topic. Method A search was made on the electronic database MEDLINE from PubMed, EMBASE and the Cochrane library. The keywords 'diverticulitis', 'perforated' and 'laparoscopy' were searched for in the titles and abstracts without language restrictions. Further studies were identified from searches on Google Scholar, as well as manual searches through reference lists of the relevant studies found. All included studies were quality assessed. Results Twelve relevant studies were included. A total of 301 patients were reported, with a mean age of 57 years. All were non-randomized studies. The majority of patients were of Hinchey classification III. All were treated with intravenous antibiotics followed by laparoscopic lavage and insertion of intra-abdominal/pelvic drains. The mean conversion rate was 4.9% and mean length of hospital stay was 9.3 days. The mean complication rate was 18.9% and the overall mortality rate was 0.25%. Subsequent elective resections with primary anastamosis were performed in 51% of patients and the majority were completed laparoscopically. Conclusion Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis appears to be a potentially effective and more conservative alternative to a Hartmann's procedure. Randomized control trials are needed to better evaluate its role. [ABSTRACT FROM AUTHOR]

Background Surgeons are increasingly considering resection and primary anastomosis when treating left-sided colonic obstruction or perforation in preference to the more traditional staged procedures. Previous studies in the United Kingdom (UK) and United States of America (USA) have suggested a greater interest in single-staged procedures amongst UK surgeons. This study was aimed to directly compare the treatment preferences between UK and US surgeons. Method A questionnaire, designed to determine the procedure of choice when faced with left-sided colonic emergencies in patients with good and poor anaesthetic risk, was sent to 500 surgeons in the UK and 500 surgeons in the USA. Results UK surgeons were more likely to perform resection, primary anastomosis and on-table colonic lavage in patients with sigmoid obstruction (good anaesthetic risk: P < 0.0001; poor risk: P < 0.01) and sigmoid perforation (good risk: P < 0.0001). In good-risk patients with sigmoid obstruction, US surgeons were more likely than UK to choose Hartmann’s procedure ( P < 0.0001). US surgeons performing primary anastomosis were less likely to perform on-table lavage. Conclusion Single-stage procedures are widely accepted as viable treatment options in both the UK and the USA when dealing with left-sided colonic emergencies. British surgeons are more likely to favour single-staged procedures, particularly with on-table colonic lavage, when compared with US surgeons. [ABSTRACT FROM AUTHOR]