O. M. Jones

ACPGBI Position Statement on Elective Resection for Diverticulitis

Diverticular disease is common, with a frequency that increases with age. Most patients with diverticulosis do not develop symptoms, though a number will develop inflammation or diverticulitis. This inflammation may develop into an abscess or free perforation. Whilst the prevalence of perforation has increased from 2.4 per 100 000 in 1986 to 3.8 per 100 000 in 2000 according to one study [1], the majority of patients with diverticulitis follow an indolent clinical course. There has been controversy, therefore, as to whether elective resection after acute diverticulitis is justified [2]. This position statement is presented in sections dealing with the pathology, symptomatology and investigation of diverticular disease and its consequences. It then examines the evidence and indications for surgical intervention and its timing. The issue of laparoscopic versus open resection is then considered. The evidence is briefly summarized under the heading ‘Findings’ and this is followed where relevant by ‘Recommendations’.

The relationship between internal rectal prolapse and internal anal sphincter function

Aim  Faecal incontinence is commonly seen in patients with internal rectal prolapse (IRP), although the mechanism is not clear. This study assessed the relationship between IRP and anal sphincter function.

Isolated colonic inertia is not usually the cause of chronic constipation

Aim  Chronic constipation is classified as outlet obstruction, colonic inertia or both. We aimed to determine the incidence of isolated colonic inertia in chronic constipation and to study symptom pattern in those with prolonged colonic transit time.

Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse.

Limited literature exists on whether slow colonic transit adversely influences the results of outlet obstruction surgery. We compared the functional results of laparoscopic ventral rectopexy (LVR) for obstructed defaecation secondary to high grade internal rectal prolapse in patients with normal and slow colonic transit.

Excellent response rate of anismus to botulinum toxin if rectal prolapse misdiagnosed as anismus (‘pseudoanismus’) is excluded

Aim  Anismus causes obstructed defecation as a result of inappropriate contraction of the puborectalis/external sphincter. Proctographic failure to empty after 30 s is used as a simple surrogate for simultaneous electromyography/proctography. Botulinum toxin is theoretically attractive but efficacy is variable. We aimed to evaluate the efficacy of botulinum toxin to treat obstructed defecation caused by anismus.

A two centre experience of transanal total mesorectal excision.

Transanal total mesorectal excision (TaTME) offers a promising alternative to the standard surgical abdominopelvic approach for rectal cancer. The aim of this study was to report a two‐centre experience of this technique, focusing on the short‐term and oncological outcome.

Rectal hyposensitivity is uncommon and unlikely to be the central cause of obstructed defecation in patients with high-grade internal rectal prolapse

Background  There are several causes of obstructed defecation one of which is thought to be internal rectal prolapse. Operations directed at internal prolapse, such as laparoscopic ventral rectopexy, may improve obstructed defecation symptoms significantly. It is not clear whether the obstructed defecation with internal prolapse is a mechanical phenomenon or whether it results changes in rectal sensitivity. This study aimed to evaluate rectal sensory function in patients with obstructed defecation and high‐grade internal rectal prolapse.

Transanal rectal resection: an initial experience of 20 cases.

Low anterior resection (LAR) can present a formidable surgical challenge, particularly for tumours located in the distal third of the rectum. Transanal total mesorectal excision (taTME) aims to overcome some of these difficulties. We report our initial experience with this technique.

Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation

Pelvic floor retraining is considered first‐line treatment for patients with faecal incontinence or obstructed defaecation. There are at present no data on the effect of a high grade internal rectal prolapse on outcomes of pelvic floor retraining. The current study aimed to assess this influence.

Endoscopically assisted extralevator abdominoperineal excision

Extralevator abdominoperineal excision (ELAPE) has been advocated to optimize clearance of lower third rectal cancers with an involved or threatened circumferential resection margin. ELAPE could reduce positive margins and specimen perforation compared with standard abdominoperineal excision. However, there can be difficulties with ELAPE, particularly in identifying the anterior plane in male patients. Usually, the dissection is performed in the prone position, which can be hazardous, particularly in obese patients in whom wound problems are commonly encountered. We describe an endoscopically assisted approach for ELAPE in the lithotomy position.