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Objective: This is a prospective study to review the natural history of anorectal dysfunction after primary repair for third or fourth degree obstetric tear and to identify the predictive factors for significant faecal incontinence., Method: From January 2003 to December 2005, 121 consecutive women (mean age 29.9 +/- 4.7) who sustained third or fourth degree obstetric tears were assessed. All had primary repair by obstetricians. They were assessed using anorectal physiology testing and endoanal ultrasound. Short-term (3-month postpartum) and medium-term (mean 18.8 +/- 7.7 months) Wexner's continence scores were obtained., Results: Among the 121 women, seven were excluded because of incomplete follow-up. At short-term assessment, 25 out of 114 women were incontinent. One of them underwent another sphincter repair for significant faecal incontinence. Twenty-one and three patients respectively, had mild (Wexner's score 1-4) and moderate (Wexner's score 5-8) symptoms. At medium-term assessment, 24 patients remained incontinent; of these, 20 had mild symptoms (Wexner's score 1-4) and four had moderate incontinence (Wexner's score 5-8). The parity (P = 0.04), degree of obstetric tear (P = 0.036) and short-term Wexner's scores at 3 months postpartum (P < 0.0001) were significantly related to the change in Wexner's scores at medium-term assessment. However, the short-term Wexner's score was the only identifiable predictive factor for significant faecal incontinence., Conclusion: Most women suffering from third or fourth degree obstetric tear were continent or mildly incontinent. Poor Wexner's score at short-term assessment at 3 months postpartum was predictive of faecal incontinence in the medium-term.

Purpose: Laparoscopic colorectal surgery is often prolonged and may cause hypothermia. It is uncertain if heated and humidified carbon dioxide (CO(2)) in laparoscopic colorectal surgery is beneficial. This is a prospective case-matched study on the use of heated and humidified CO(2) in patients undergoing laparoscopic colorectal surgery., Method: Twenty consecutive patients undergoing laparoscopic colorectal surgery with heated (36 degrees C) and humidified (95%) CO(2) were compared with 20 consecutive patients using standard CO(2) (30.2 degrees C). All procedures were performed by a single surgeon in an institution. The changes in core temperature during surgery, visual quality of images and the short-term clinical outcome were documented., Results: The core temperature fell during surgery in both groups. Although the fall of core temperature was more in the control group, it was not statistically significant (P > 0.05). The passage of flatus was more delayed in heated and humidified group (P = 0.004), but it did not affect the hospital discharge. All the other parameters, including the quality of visual images and the postoperative pain, were similar in both groups., Conclusions: Despite better temperature maintenance (nonsignificant), pneumoperitoneum using heated and humidified CO(2) gas did not appear to have any clinical benefits in laparoscopic colorectal surgery.

Objective: To evaluate the current place of laparoscopy in the management of colorectal disease., Method: A literature search was undertaken on Medline between the period 1991 and 2002., Results: From the literature there is good evidence that the laparoscopic approach is associated with at least some short-term advantages. Improved cosmesis and better patient's satisfaction are also evident. Because of this laparoscopy has been widely employed in various benign conditions. Among others, laparoscopic stoma formation, laparoscopic resection for diverticular disease and Crohn's disease, laparoscopic rectopexy, as well as laparoscopic assisted reversal of Hartmann's procedure were commonly reported. As port site recurrence and oncological safety are of less concern, there have been increasing reports on laparoscopic resection for colorectal cancer. Although long-term follow up data is still limited, results of large prospective studies as well as various randomized trials show that recurrence and survival rates of the laparoscopic approach were at least comparable to open surgery. As experience and confidence accumulates, there are also increasing reports on technically demanding, laparoscopic sphincter-saving rectal excision. Articles on functional aspects following this type of resection also start to appear, which might be one of the future directions., Conclusion: The applicability of laparoscopy to colorectal disease continues to expand. Laparoscopic approach should be considered for patients with benign conditions. For colorectal cancer, results from randomized trials so far have been favourable. Hence, the authors suggest the utility of laparoscopy in potentially curable cancer can also be judiciously relaxed.