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Background: Securing of the appendix stump is one of the key steps in performing laparoscopic appendicectomy (LA). This can be achieved by a variety of methods including endoloops, stapler, and cli...

Surgeons have historically learned their craft through the apprenticeship model from their mentors. Knowledge and practices acquired this way can rapidly become outdated. Providing high-quality care to patients requires surgeons to keep their knowledge up to date in line with evolving new evidence. The principles of evidence-based medicine (EBM) and its application to surgery, evidence-based surgery (EBS), are pivotal in updating and refining surgical practice. Changing from the conventional practice of surgical education to a structured evidence-based format requires a transformative process in all the levels of surgical practice encompassing trainees and trainers. Equally important is providing an optimal environment to review the evidence and deliver the surgical teaching and incorporate effective assessment tools to monitor the process. In this article, we revisit the levels of evidence and explore the different issues related to EBS such as barriers to EBS, incorporation of EBS to the surgical curriculum and discuss practical ways to implement EBS in the surgical curriculum.

Rectal prolapse and faecal incontinence are relatively common conditions that present to the colorectal and pelvic floor clinics. Both can be complex to treat given they are often multifactorial in origin and tend to present in elderly comorbid patients. Treatment often involves significant patient or family participation, particularly for faecal incontinence, and therefore patients and their families need to understand the risks and benefits of all treatment options available to them. This article outlines the currently available surgical interventions for rectal prolapse and faecal incontinence to allow the surgical trainee to begin these conversations in the clinic.

Benign perianal conditions commonly present on the acute general surgical take and in the outpatient setting. Accurate diagnosis and appropriate management is not only important in prevention of patient morbidity but also important in differentiation of these conditions from cancers. This article summarizes the presentation and current management of perianal abscess, fistula in ano, haemorrhoids, fissure and pilonidal sinus.

BackgroundTo our knowledge, we report the first case of an aneurysmal benign fibrous histiocytoma occurring in the anal canal.MethodsClinical, histological, radiological and surgical data pertaining to this patient were analysed. Additionally, a literature review on aneurysmal benign fibrous histiocytoma was conducted.ResultsWe describe a 48-year-old Caucasian male presenting with a 2-week history of a painful anus, fresh rectal bleeding and tenesmus. Digital rectal examination identified a tender firm mass in the anal verge. Magnetic resonance imaging revealed high signal in the anal canal. Flexible sigmoidoscopy revealed an ulcerated 3-cm indurated lesion at the four o’clock position. Biopsies taken of the mass confirmed the diagnosis of an aneurysmal benign fibrous histiocytoma (BFH). Following a discussion in the colorectal multi-disciplinary team, the patient was counselled for an excision of the lesion. Diathermy dissection was performed to completely excise the tumour with a margin involving the fibres of the anal sphincter. The patient made a full recovery and had no residual symptoms. Histology of the excised specimen confirmed clear margins of the BFH.ConclusionsThis paper aims to highlight a rare differential diagnosis for an anal mass. An aneurysmal BFH most often presents as a painless mass within the dermis and subcutaneous tissue. As such, this case presents a diagnostic challenge to both colorectal surgeon and histopathologist due to its low incidence and unusual location. We further present the clinical and radiographic evidence to confirm the diagnosis. Additionally, we discuss the literature pertaining to this condition and its optimal management.

Laparoscopy has already established itself as the preferred surgical approach in a variety of elective surgical conditions. Along with its usual advantages of less tissue trauma and faster recovery, its diagnostic as well as therapeutic role is making it an attractive option in emergency surgery. In this paper, we have reviewed the current status of laparoscopic surgery in luminal gastrointestinal emergencies. Relevant papers were selected using Medline database from 2007 to the present. These were reviewed, and outcomes were stated under the headings of appendicitis, perforated peptic ulcer, colorectal emergencies and small bowel obstruction. The laparoscopic intervention was found to be of clear benefit in most of the patients with appendicitis. Its role, however, is not absolutely clear in managing perforated peptic ulcers. Laparoscopic lavage and drainage have been recommended in diverticular perforation with limited contamination. Small case series and studies have shown benefits of laparoscopic surgery in iatrogenic colonic perforations, colonic obstruction, emergency colectomy and small bowel obstruction. Laparoscopic surgery can be recommended in appendicitis and low-risk cases of perforated peptic ulcers. Its definitive role in other conditions needs more evidence. The surgeon’s experience and careful patient selection are very important to improve the outcome.