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Colorectal metastases to the liver are increasingly being detected and accurately characterized at an earlier stage and even at the subcentimeter level. The oncological case for surgical resection of this disease is widely accepted. The advent of smaller volume disease has encouraged the development of in situ ablative technologies over the last two decades and the oncological efficacy of these procedures has continued to improve through stepwise developments in ablation devices and image guidance. This article provides an overview of these techniques, currently available and future technologies, and the imaging findings encountered. It also sets out the current position image-guided ablation merits alongside chemotherapy and surgical resection. In selected cases ablation for colorectal metastases can produce oncological outcomes equivalent to surgery and critically with less morbidity in an increasingly older patient population. We examine whether with careful patient selection, optimal technology, meticulous technique, and diligent follow-up, consistently reproducible high quality outcomes will be achieved in the next few years.

Colorectal cancer is one of the leading causes of mortality in the Western world. Half of patients with colorectal cancer will develop liver-metastatic (CLM) disease, with fewer than 30% having surgically resectable disease at diagnosis. It is well established in the literature that major hepatectomy offers a high rate of R0 resection, however, with concommitant increased rates of mortality and morbidity. Emerging literature during the past two decades has demonstrated the potential superiority of parenchymal-sparing hepatectomy (PSH) in treating CLM disease in terms of oncological outcomes, survival and re-operation in cases of recurrence (salvageability). To date, no data regarding the evaluation of quality of life and cost after PSH have been published. PSH seems to be correlated with less mortality and morbidity, which can be translated in lower re-admission rates, better quality of life and, therefore, reduced relevant cost. Prospective studies and clinical trials evaluating the multiple beneficial role of a PSH surgical strategy in CLM disease are mandatory to support or reject the emerging belief that PSH could be the gold standard of treatment of CLM disease.

Background/Aims: To compare short- and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in obese (body mass index >30 kg/m2) patients. Patients and Methods: Sixty-four consecutive obese patients who underwent laparoscopic (LPS) right colectomy with IA were matched with 64 patients who underwent LPS right colectomy with EA. Intraoperative variables, short-term outcomes, readmission rates, and morbidity and mortality rates were analyzed along with long-term outcomes. Results: Conversion to open surgery occurred in 4 patients in the IA group and 11 patients in the EA group (p = 0.097). The overall 30-day morbidity rate was 29.6% in the IA and 32.8% in the EA (p = 0.70). No 30-day mortality occurred. Anastomotic leak occurred in 4.7% of patients in the IA group vs. 7.8% in the EA group (p = 0.71). In the IA group, an earlier recovery of bowel function was observed (p = 0.01). No differences were observed with respect to the length of stay and reoperation rate. No 30-day readmission occurred in the IA compared to 5 patients readmitted in the EA group (p = 0.058). A higher incidence of incisional hernia was observed in the EA group (p = 0.033). Conclusion: IA in obese patients is associated with similar short-term outcomes, lower incidence of incisional hernias, and might possibly reduce the risk of hospital readmission.

Laparoscopic surgery has become well established in the management of both benign as malignant colorectal disease. However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery. We have critically review the indications and the results of the laparoscopic approach for the treatment of acute colorectal disease. A systemic review based on comprehensive Literature research was made on Pubmed with the primary objective to identify all clinical relevant randomized controlled trials (RCT). However, other reports, population based outcomes studies, case series and case reports were also included. Cross-link control was than performed with Google Scholar and Cochrane library databases. We have reviewed the last years' evident literature about this last topic and the results reported , although mainly early, controversial and focused on the short term, enabled us to generally conclude that in a proper setting, laparoscopic colorectal emergency surgery is feasible, effective, safe and beneficial for patients to be a part of a common surgical practice, as long as adequate training is obtained and proper preparation observed when more advanced procedures are attempted in critically patients.

Aim The increased utilization of smartphones within the clinical environment together with connected applications (apps) provides opportunity for doctors, including coloproctologists, to integrate such technology into clinical practice. However, the reliability of unregulated medical apps has recently been called into question. Here, we review contemporary medical apps specifically themed towards colorectal diseases and assess levels of medical professional involvement in their design and content. Method The most popular smartphone app stores (iPhone, Android, Blackberry, Nokia, Windows and Samsung) were searched for colorectal disease themed apps, using the disease terms colorectal cancer, Crohn’s disease, ulcerative colitis, diverticulitis, haemorrhoids, anal fissure, bowel incontinence and irritable bowel syndrome. Results A total of 68 individual colorectal themed apps were identified, amongst which there were five duplicates. Only 29% of colorectal apps had had customer satisfaction ratings and 32% had named medical professional involvement in their development or content. Conclusion The benefits of apps are offset by lack of colorectal specification. There is little medical professional involvement in their design. Increased regulation is required to improve accountability of app content.

Aim Instrument crowding is encountered in single-incision laparoscopic surgery (SILS). Our aim was to compare the results of SILS with those of conventional laparoscopic surgery (CLS) for malignant colorectal disease. Methods The records of 27 patients who received SILS for the treatment of malignant disease using a home-made multiple-port system were compared with those of 68 patients who received CLS performed in a standard manner using four to five trocar sites. Results There were no significant differences in age, gender, disease stage, tumour location or tumour size between the SILS and CLS groups. The most common surgery was high anterior resection in both groups (SILS, 63.0%vs CLS, 58.8%). There were no significant differences between the groups in types of surgery performed, length of bowel resected, resection margin, blood loss, duration of surgery or postoperative complications. Postoperative pain scores were significantly higher in the SILS group than in the CLS group (3.07 ± 1.14 vs 2.41 ± 0.63, respectively, P

Aim: This study analysed trends in polypoid colorectal cancer (PCRC) diagnosed by colonoscopy during the period 1995-2008 and compared the patterns observed in the years 2005-2008 with 1995-1998. Method: In the period 1995-2008, 24245 colonoscopies were performed and 1041 patients with PCRC were diagnosed: pediculated (n=220) or sessile (n=821). Results: The mean age at diagnosis was 68.3± 11.6years. Males were more likely to have PCRC (males 62.6%vs females 37.4%; P

The management of patients with colorectal disease in the pediatric population is challenging. Such management is all the more challenging when facing the constraints imposed by an environment with limited clinical resources. Three types of colorectal problems are highlighted in this article: anorectal malformations, Hirschsprung's disease, and acquired rectovaginal fistula in the human immunodeficiency virus-positive population. Through the use of illustrative cases, the authors discuss the pitfalls and challenges encountered in the diagnosis, treatment, and appropriate disposition of these patients. The bulk of the experience used to write this article was acquired in low- and middle-income countries in Africa. The authors hope that the lessons learned will help others manage such patients in the context of limited resources, but recognize that challenges will vary from place to place. There is no substitute for local, contextual expertise.

We read the article written by Westerduin and colleagues published in the Colorectal Disease Journal (1). Their purpose was to determine the clinical success and morbidity after redo coloanal anastomosis (CAA) (1). They found that leakage of the redo CAA was the only risk factor for a permanent stoma (OR: 0.022; 95% CI: 0.004 - 0.122). This article is protected by copyright. All rights reserved.

Minimally invasive surgery has become mainstream in surgical management of colorectal disease. Based on evidence of oncologic safety and benefit to patients, laparoscopic colorectal surgery is regarded as a successful alternative to open surgery. Since the introduction of the da Vinci® system as another tool for minimally invasive surgery, there have been several reports regarding the feasibility and safety of the system. The authors looked at their experience with 412 robotic colorectal surgeries and found that it was feasible and safe. Incidence of operation-related morbidity was around 11 per cent and system-related problems were 2.4 per cent. There was no operation-related or system-related mortality. From a technological perspective, robotic surgery has several advantages over laparoscopic surgery, including a magnifying view with a three-dimensional image, a stable camera platform, and instruments with Endowrist® technology that allow for seven degrees of freedom of movement. However, there is still room for improvement. The revolution of robotic technology can aid in the realization of a dream: a smaller, cheaper, and more sophisticated robotic system, which will further facilitate the widespread application of robotic surgery to colorectal disease.

This manuscript represents a compilation of summaries from the reoperative symposium at the SAGES 2007 conference in Las Vegas, Nevada. The symposium addressed reoperative laparoscopy for several common diseases including colorectal disease, gastroesophageal reflux, hernias, bariatric, and pediatric surgery. The preoperative assessment is crucial to the success of each procedure. Prior to any intervention the underlying functional, mechanical, or pathophysiological disorder must be identified to ensure the success of the reoperative laparoscopic procedure. The ensuing manuscript summarizes the oral presentations and discusses several technical aspects for each disorder.

Patients with intellectual disabilities (ID) who present for endoscopic examination appear to be a relatively small minority. However, the literature suggests that those patients who do present may be the tip of an iceberg of undiagnosed gastric and colorectal disease (NHS Health Scotland, 2004). For those who manage to gain access to endoscopic examination, their pathway through the diagnostic process needs to be managed effectively and compassionately.

The enhanced recovery programme (ERP) has been running for over a year at Torbay Hospital, a 500−bedded district general hospital in south−west England. There are approximately 200 new cases of colorectal cancer per year, resulting in 150 operations. In addition, 100 cases of benign colorectal disease also require surgical intervention. This article sets out the key evidence that underpins the ERP in colorectal surgery, and describes the process of implementation and the impact this has had on patients, staff and the wider team.

Dr Anjali S. Kumar, MD, MPH, FACS, FASCRS, is a colon and rectal surgeon at MedStar Washington Hospital Center and an assistant professor of Surgery at Georgetown University. She serves as Academic Director for the regional MedStar Colorectal Surgery Program of MedStar Health, which is the largest health-care provider in the Maryland and metropolitan Washington, DC region. She directs the research efforts of the residency in colon and rectal surgery which has been hosted by Washington Hospital Center for 15 years. Dr. Kumar has won many awards and grants for her research and activism in the field of women's health, and she has published numerous articles on early cancer detection, treatment, and prevention. Among other honors, she has received the Chancellor's Award for the Advancement of Women from the University of California, San Francisco (UCSF). At Washington Hospital Center, Dr. Kumar is the site's Principal Investigator of several multi-institutional clinical trials investigating the role of chemotherapy and radiation therapy in the treatment of locally advanced rectal cancer. Dr. Kumar is a Fellow of the American College of Surgeons and serves as a counselor for the DC chapter. She is a Fellow of the American Society of Colon and Rectal Surgeons (for whom she is the Chair of the Young Surgeons Committee), a member of the Society of American Gastrointestinal and Endoscopic Surgeons (for whom she is a 3-year member of the Research and Grants Committee), and a member of the Association of Women Surgeons (for whom she is the DC Chapter President and Councilor to the national organization). She serves as the former program director and current Secretary/Treasurer for the Chesapeake Colorectal Society, the regional specialty society of the mid-Atlantic area. Her research has been published in peer-reviewed journals, including Diseases of the Colon and Rectum, The Surgical Clinics of North America, and Colorectal Disease. She is certified by the American Board of Surgery and the American Board of Colon and Rectal Surgeons. Her medical degree is from the University of Washington, Seattle, and her Master of Public Health degree is from Harvard University, Boston. She completed a general surgery residency at UCSF's East Bay program in Oakland, CA. Following her residency, she completed a fellowship in colon and rectal surgery at the New York Presbyterian Hospital of Cornell and Columbia Universities/Memorial Sloan Kettering Cancer Center. She has been in practice in Washington, DC since 2009. On behalf of the readers and staff of Clinics of Colon and Rectal Surgery, I sincerely thank Dr. Kumar for serving as a Guest Editor and for providing us with a superb issue on miscellaneous colitides.

Prostate cancer (PC) is the most commonly diagnosed cancer in men. More than 1.1 million cases of PC were recorded worldwide in 2012 [1], and the estimated mortality of 307,481 showed a marked increase compared to the 258,000 deaths estimated in 2008 [2]. It is the second most common cause of cancer mortality in Western countries after lung cancer, and the incidence was estimated to be 417 new cases per 100,000 men in Europe in 2012 [3]. It is now fourth on the scale of the total economic cancer-related costs in Europe after lung, breast and colorectal diseases with an estimated cost of 8.43 billion euros in 2009 [4].

There are three types of laparoscopic surgery for colorectal disease, medial-to-lateral, lateral-to-medial and the retroperitoneal laparoscopic approach. The purpose of the present study is to evaluate the long-term results of laparoscopic colectomy for colorectal cancer by the transabdominal and retroperitoneal laparoscopic approaches, to provide current status of clinical outcomes of laparoscopic surgery including acceptable ranges of complications, morbidity and survival rate. Many transabdominal operations have been reported the clinical outcomes either one surgical team or multiple center series in recent decades. However, only one journal reported retroperitoneal laparoscopic surgery, including data of 309 patients at Sakura National Hospital from June 1994 to March 2003. Ten cases (3.2%) were converted to open colectomy and nine of these were in the first 100 cases (1.9%) compared with only one within the other 209 patients (0.47%), this being within a reasonable range 0%−3.2%. There were no port site recurrences. Eight patients had lung and/or liver metastases and died of disease. The average survival time was 28.4 months. The 5-year survival rates were 100%, 89.7%, 85.5% and 72.9% for stages I, II, IIIa and IIIb, respectively. In a literature review of journals for laparoscopic surgery for colorectal cancers, the conversion rate is variable from 0 to 17%, and the local recurrence rate is generally usually below 6.8%. The 5-year survival rates are approximately 97-89%, 88-78% and 67-59% for stages I, II and III, respectively.

Anal sphincter weakness and rectal sensory disturbances contribute to faecal incontinence (FI). Our aims were to investigate the relationship between symptoms, risk factors, and disordered anorectal and pelvic floor functions in FI.In 52 women with "idiopathic" FI and 21 age matched asymptomatic women, we assessed symptoms by standardised questionnaire, anal pressures by manometry, anal sphincter appearance by endoanal ultrasound and magnetic resonance imaging (MRI), pelvic floor motion by dynamic MRI, and rectal compliance and sensation by a barostat.The prevalence of anal sphincter injury (by imaging), reduced anal resting pressure (35% of FI), and reduced squeeze pressures (73% of FI) was higher in FI compared with controls. Puborectalis atrophy (by MRI) was associated (p0.05) with FI and with impaired anorectal motion during pelvic floor contraction. Volume and pressure thresholds for the desire to defecate were lower, indicating rectal hypersensitivity, in FI. The rectal volume at maximum tolerated pressure (that is, rectal capacity) was reduced in 25% of FI; this volume was associated with the symptom of urge FI (p0.01) and rectal hypersensitivity (p = 0.02). A combination of predictors (age, body mass index, symptoms, obstetric history, and anal sphincter appearance) explained a substantial proportion of the interindividual variation in anal squeeze pressure (45%) and rectal capacity (35%).Idiopathic FI in women is a multifactorial disorder resulting from one or more of the following: a disordered pelvic barrier (anal sphincters and puborectalis), or rectal capacity or sensation.

Progress in colorectal surgery over the last few years is evident by the growing number of randomised controlled trials reported. We have scrutinised such trials reported over the last year across the entire spectrum of colorectal disease and have presented the significant findings in this trials report.

Aim Most consultants participating as referees in the peer review process of papers submitted to scholarly journals have had no training or tuition. This study attempted to evaluate the effect on reviewing of a half-day course held at the Royal Society of Medicine. Method Registered consultant delegates were sent two ‘doctored’ papers, a case report and an original paper, well before the meeting to review at home using the standard computerized score sheet issued with referee requests by Colorectal Disease. At the start of the meeting the scores were entered into a computer as ‘Before’. After each paper had been presented and then discussed, it was re-marked to give the ‘After’ score. The Before and After scores were compared with the post-meeting feedback forms. Results The Before and After scores provided by the participants for the two papers each reviewed were not significantly different for the questions relating to the publication/rejection decision. The Before score was higher than the After score for questions relating to the Abstract, Introduction and Method sections. Feedback forms regarding the tuition were universally positive and appreciative. Conclusion Consultants already have the expertise to decide whether a paper should be rejected. The study day appears to give an additional insight that may change an initial opinion. In general a paper scored before the meeting was scored lower after it was presented and discussed at the meeting (the tuition).

Minimally invasive surgery has been shown to offer many advantages to general surgical patients but has not been widely adopted for colorectal disease. Initial fears surrounding the oncological safety of laparoscopic colectomies have largely subsided but the technical challenges still remain. Surgical robots or telemanipulators present the laparoscopic surgeon with unrivaled dexterity and vision, which may allow colonic resections to be completed with greater ease. Although initial studies suggest promising results using currently available systems, it will take further time for patient benefits to be proven, therefore justifying the greater expense of operating with this new technology.

We sought to evaluate the usefulness of multidetector CT (MDCT) arteriography with volumetric three-dimensional (3D) rendering to depict the hepatic vascular anatomy. Our study population was patients who had undergone arterial mapping in preparation for placement of a hepatic arterial floxuridine infusion pump for treatment of metastatic hepatic colorectal carcinoma.We retrospectively reviewed the medical records of 26 patients with hepatic colorectal metastases who had been scheduled for implantation of a hepatic artery pump. Before surgery, all patients underwent MDCT arteriography with volumetric 3D rendering of the hepatic vessels. The axial and 3D arteriograms were evaluated for their usefulness in depicting hepatic arterial anatomy. Subsequently, three patients also underwent catheter angiography. Twenty-two of the 26 patients imaged had a hepatic artery floxuridine infusion pump implanted. Results of the CT arteriography were correlated with findings at surgery or on catheter angiography if surgery was not performed.MDCT arteriography correctly revealed hepatic arterial anatomy in all 25 patients with angiographic or surgical confirmation. One patient with aberrant hepatic arterial anatomy did not have angiographic or surgical confirmation. Classic hepatic arterial anatomy was identified in 16 (64%) of 25 patients. The following hepatic arterial variants were found in one patient each: the common hepatic artery arising directly from the aorta; a replaced left hepatic artery; an accessory right hepatic artery; a replaced left hepatic artery and accessory right hepatic artery; a replaced right hepatic artery; a right hepatic arterial branch arising early (before the origin of the gastroduodenal artery); and replaced right and left hepatic arteries. Three patients were not suitable candidates for placement of a hepatic artery floxuridine pump. The patient who had no angiographic or surgical confirmation was also not considered a good surgical candidate because of replaced right and left hepatic arteries. Two patients (8%) had an accessory left hepatic artery.MDCT arteriography with volumetric 3D rendering is an accurate, noninvasive method of depicting hepatic arterial anatomy and, therefore, of selecting patients with colorectal metastatic disease who could benefit from hepatic artery pump implantation. Catheter angiography provides no additional information, and we have eliminated it as a routine preoperative imaging examination.

Intestinal spirochetes in humans have been recognized for more than a century, but it is still a matter of debate whether they are just commensal organisms or whether they cause colorectal disease. Most descriptions to date are of adult patients, while reports in the pediatric literature have been scarce. In a retrospective study we found eight children with intestinal spirochetosis. The findings, clinical as well as pathological, with light- and electron microscopy, are presented. In all patients, a 3 microm-thick layer of spirochetes was visualised on the luminal aspect of the epithelial cells covering the enterocytes and part of the gland openings. In five of the eight cases an inflammatory cell reaction was seen by light microscopy and in one patient a picture suggesting intracytoplasmatically located spirochetes was seen by electron microscopy. Despite partial or complete destruction of microvilli, spirochetes were still able to adhere to the enterocyte membranes. In three children there was a clear correlation between treatment and relief of symptoms. In four there was partial improvement and in one child no change in bowel-related symptoms. We believe that intestinal spirochetes may cause colorectal disease in children. Possible pathogenic mechanisms are discussed.

We read with great interest the article titled “Laparoscopic ventral rectopexy for rectal prolapse and rectal intussusception using a biological mesh” [1] published in Colorectal Disease. We believe this work is an important addition to the current literature on laparoscopic ventral Mesh rectopexy (LVMR) for rectal prolapse; however we do have a few remarks on this manuscript. This article is protected by copyright. All rights reserved.

Two studies report the generation of human colonic organoids, which could be useful for disease modelling and drug testing.

Single-incision laparoscopic colectomy may decrease parietal trauma and may offer cosmetic advantages when compared with standard laparoscopic approaches. Among the potential advantages, cosmetic is an important factor. Currently, there are no prospective randomized trials comparing single-incision laparoscopy with conventional laparoscopy, and there is little data about post-hospitalization outcomes and benefits over existing techniques. Considering this, it’s difficult to recommend widespread implementation of this technology. However, despite these limitations, we have to remember that in the beginning of conventional laparoscopic surgery, cosmetic result was the only benefit conferred. As experience grows and technology advances, this approach may become the preferred technique for surgeons in select cases.

The benefits of laparoscopic colectomy over open colectomy for colorectal disease including colon cancer have been firmly established by a number of prospective randomized-controlled trials. The hand-assisted technique offers additional advantages, making it a useful tool in the surgeon’s armamentarium. This chapter lays out the authors’ step-by-step systematic approach to hand-assisted left colectomy.

To investigate angiopoietin (Ang) and vascular endothelial growth factor (VEGF) expression in rats with ulcerative colitis (UC) and colorectal cancer (CRC).Dysplasia and cancer were investigated in rats that received three cycles of 3.5% dextran sulfate sodium (DSS) in drinking water for 7 d followed by distilled water for 14 d after intraperitoneal pretreatment with 20 mg/kg 1,2-dimethylhydrazine (DMH) (CRC group). Colitis was investigated in rats that received three cycles of 3.5% DSS in drinking water for 7 d followed by distilled water for 14 d after intraperitoneal pretreatment with saline (UC group). Rats without DSS or DMH treatment served as controls. Expression of the tyrosine kinase with immunoglobulin-like and EGF-like domains (Tie)-2 and its ligands, Ang-1 and Ang-2, as well as VEGF were evaluated in the colorectum by Western blotting.Compared with rats in the control group, rats in the CRC and UC groups developed the symptoms of acute colitis with diarrhea, rectal bleeding, wasting, and loss of body weight (P0.05). In addition, the mean length of colorectum of CRC and UC rats was significantly shorter than that of control rats (8.29 ± 0.21 and 8.31 ± 0.86, respectively, vs 12.34 ± 0.12 cm; P0.05). Furthermore, rats in the CRC group, but not in the UC or control groups, developed multiple tumors in the colorectal region. Western blot analysis revealed that rats in the CRC and UC groups had markedly increased protein levels of Ang-1, Ang-2, Tie-2, and VEGF in the colorectum compared to rats in the control group.Increased expression of Ang-1, Ang-2, Tie-2, and VEGF in ulcerative colitis-derived colorectal cancer might lead to chronic colitis and pathologic angiogenesis in rats.

AIM:The modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to reach a consensus on prioritizing clinical research questions in colorectal disease.METHOD:Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds 2 and 3 they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority.RESULTS:Five hundred and two questions were submitted in Round 1. Following two rounds of voting and analysis, a list of 25 priority questions was produced, including 15 cancer-related and 10 noncancer-related questions.CONCLUSION:It is anticipated that these results will: (i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, (ii) promote development and (iii) define funding of new research and prioritize areas of unmet clinical need where the potential clinical impact is greatest.

Anastomotic leaks are a dreaded surgical complication following colorectal operations. Creation of a temporary proximal diverting ileostomy is used in high‐risk anastomoses, however, additional surgical risk is accumulated with its creation and reversal. Endoluminal vacuum therapy has been shown to seal anastomotic defects in the prophylactic setting in a pig model and we hypothesized it could be utilized in a delayed fashion to rescue subjects with an active anastomotic leak. Yorkshire pigs underwent rectal resection, intentional leak confirmed by fluoroscopy, and endoluminal vacuum therapy device placement to low continuous suction. Following treatment, a contrast enema and necropsy was performed for gross and histopathology. Pigs underwent 2 (or 5) days of free intraperitoneal leak prior to device placement and 5 (or 7) subsequent days of endoluminal vacuum therapy. Six of seven early‐treated pigs sealed their anastomotic defect, while two of the four treated pigs in this extended group sealed the defect. Endoluminal vacuum therapy is feasible and well tolerated in a pig model, and it has been shown to seal a significant number of freely leaking anastomoses in the early period (86%). This technology warrants further study as it may provide a noninvasive means to treatment of anastomotic leaks.

DOI links to 'Erratum'. Open Access URL links to the full journal article published in International Journal of Colorectal Disease, 2010, 25(6), pp.703-712.

Restorative proctocolectomy with ileal pouchanal anastomosis is the surgical option favoured by most in the definitive treatment of mucosal ulcerative colitis and familial adenomatous polyposis. Throughout this century, the operation has evolved from a concept to a very refined procedure which cures the underlying colorectal disease, restores bowel function and promises a quality of life superior to that of other surgical options. Each component of the operation whether it be the design of the reservoir or the necessity for a temporary ileostomy has been the subject of some degree of controversy, but the most debated aspect remains whether a transanal mucosectomy is detrimental and what type of ileoanal anastomosis is preferable, i.e. hand sewn to dentate line area or stapled at the level of proctectomy. This debate has arisen in part to simplify the operation, and in part to try to minimize complications and improve function, especially nighttime incontinence. The advantages and disadvantages of each current approach are reviewed and conclusions drawn from our own experience and that of others. Further research will be needed to improve continence and clarify the nature of pouchitis, which may in turn lead to the discovery of the cause of ulcerative colitis.