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Objective: This prospective study aimed to evaluate the efficacy and safety of 4% formalin dab in managing patients with refractory radiation proctitis. Methods: From January 2001 to December 2004, 11 patients with radiation proctitis who did not respond to regular steroid enemas and/or argon plasma coagulation were treated with local application of 4% formalin-soaked gauze (formalin dab). Main outcome measures were control of bleeding, changes in haemoglobin level, hospitalization and blood transfusion requirements, and complications. Results: The mean haemoglobin level before formalin dab was 7.3 ± 2.4 g/dL. Eight patients had required repeated admissions to hospital for blood transfusions (median 4 units; range, 2–27 units). The median number of sessions of formalin dab was two (range, 1–6). The treatment was effective in 10 patients (90.9%): four patients had complete cessation of bleeding and six patients had improvement of symptoms. At a median follow-up of 15.3 months, only three patients required hospital admission once for blood transfusions (range 1–2 units). The mean haemoglobin level after formalin dab was 10.4 ± 2.2 g/dL, which was significantly higher than that before formalin dab (P = 0.007). No patient developed complications after formalin dab. Conclusions: Formalin dab is an effective and safe treatment modality for refractory radiation proctitis.

Background: Post-haemorrhoidectomy wound pain is often the focus of concern for patients as well as their clinicians. Despite the recent enthusiasm brought about by stapled haemorrhoidectomy, conventional haemorrhoidectomy still remains the mainstay of surgical treatment for symptomatic third and fourth degree haemorrhoids in places where healthcare funding cannot afford these expensive devices. The present study aims at evaluating the effectiveness of pre-emptive analgesia and oral metronidazole in reducing wound pain and complications after open haemorrhoidectomy. Method: Patients with symptomatic third or fourth degree haemorrhoids undergoing open haemorrhoidectomy were randomized into four groups. Group 1 received pre-emptive analgesia (0.5% bupivacaine). Group 2 received oral metronidazole (400 mg three times daily for 1 week). Group 3 received both treatments while group 4 was the control group. Results: Number of patients recruited was 105. There was no significant difference among the four groups in terms of pain scores on the first three postoperative days, analgesic requirements, hospital stay and the time to return to normal daily activities. Patients who received oral metronidazole had significantly less pain at the time of the first bowel motion (P = 0.037). Conclusion: Oral metronidazole significantly reduces pain during the first bowel motion after open haemorrhoidectomy. Pre-emptive analgesia with 0.5% bupivacaine does not reduce postoperative pain.

Objective: The aim of the present study was to review our experience in the surgical management of patients with obstructing colorectal cancers over an 11-year period, 1987–1997. Patients and methods: Retrospective review of case records of 275 patients (male: 177; female 98) who had undergone emergency surgery for obstructing colorectal cancers was performed. Tumours proximal to splenic flexure were defined as proximal tumours while those at or below the splenic flexure were defined as distal tumours. Results: The obstruction was caused by proximal tumours in 88 (32%) patients. The resection rate and the primary anastomotic rate were higher for proximal tumours compared with distal tumours (95.5%vs 85.6%, P = 0.014; 92%vs 30.5%, P

Objective: To study the clinical characteristics, investigations, management and pathology in adult colonic intussusception. Methods: A retrospective study of seven adult patients who were operated on for the diagnosis of colonic intussusception in our department from January 1999 to September 2003 was carried out. The case records of the seven patients were retrieved. Their clinical presentations, investigations, operative records and pathology were studied. Results: The mean age of the patients was 67.4 years. There were four men and three women. Five of the patients presented with chronic non-specific symptoms and the other two patients presented with acute symptoms. Transabdominal ultrasonography (USG) and computed tomography (CT) scan were used for investigation. In the majority of the patients (87.5%), radiological features of intussusception were shown by USG or CT scan. All seven patients underwent laparotomy exploration with bowel resection. Six patients (85.7%) had lead points with definable pathology. Within the lead points, five patients had primary malignant lesions. Conclusion: With more liberal use of imaging techniques, more adult intussusception can be diagnosed before explorative surgery. Ultrasound would be an ideal tool for initial evaluation. In view of the high chance of associated malignancy, adult colonic intussusception should be resected without prior reduction at the time of surgery.

Aim: The aim of this study was to compare the operative and short-term clinical outcomes of emergency laparoscopic-assisted versus open right hemicolectomy for complicated caecal diverticulitis. Methods: Between September 2001 and June 2006, 18 consecutive patients with complicated caecal diverticulitis underwent emergency right hemicolectomy at out institution, six with the laparoscopic-assisted approach and 12 with the open approach. Clinical data were prospectively recorded and compared between the two groups. Results: There were no significant differences between the two groups with respect to age, gender, comorbidities, duration of symptoms, and Hinchey staging. There was no conversion in the laparoscopic-assisted group. Compared to the open group, the laparoscopic-assisted group had a slightly longer operative time (167.5 vs 150 min, P = 0.083) but significantly less blood loss (35 vs 100 mL, P = 0.041). Although the median time to first bowel motion was significantly shorter in the laparoscopic-assisted group (3 vs 5 days, P = 0.041), the time to full ambulation and the duration of hospital stay were similar between the two groups. The postoperative complication rates (50% vs 33.3%), as well as the hospital readmission rates for complications (33% vs 0%), were higher in the open group than the laparoscopic-assisted group, but the differences did not reach statistical significance. Conclusion: Emergency laparoscopic-assisted right hemicolectomy for complicated caecal diverticulitis is feasible and safe in the hands of experienced surgeons. Compared with the open approach, the laparoscopic-assisted approach is associated with less blood loss and earlier return of gastrointestinal function.