Peak wall stress can be calculated from routinely performed CT scans and may be a better predictor of risk of rupture than AAA diameter on an individual patient basis.

A centralized approach facilitated high volume experience in a single centre with an increase in the completeness of surgical excision rates and a reduction in mortality and morbidity over time.

Robotic colorectal surgery is a promising field and may provide a powerful additional tool for optimal management of more challenging pathology, including rectal cancer. Further studies are required to better define its role.

Aim:Robotic colorectal surgery is an emerging field and may offer a solution to some of the difficulties inherent to conventional laparoscopic surgery. The aim of this review is to provide a comprehensive and critical analysis of the available literature on the use of robotic technology in colorectal surgery. Methods:Studies reporting outcomes of robotic colorectal surgery were identified by systematic searches of electronic databases. Outcomes examined included operating time, length of stay, blood loss, complications, cost, oncological outcome, and conversion rates. Results:17 Studies (9 case series, 7 comparative studies, 1 randomised controlled trial) describing 288 procedures were identified and reviewed. Study heterogeneity precluded a meta-analysis of the data. Robotic procedures tend to take longer and cost more, but may reduce the length of stay, blood loss, and conversion rates. Complication profiles and short term oncological outcomes are similar to laparoscopic surgery. Conclusions:Robotic colorectal surgery is a promising field and may provide a powerful additional tool for optimal management of more challenging pathology, including rectal cancer. Further studies are required to better define its role.

Keeping the umbilical cord long and milking may be an effective method for improving Hb and iron stores at 6 months of age in term-infants.

Peak wall stress can be calculated from routinely performed CT scans and may be a better predictor of risk of rupture than AAA diameter on an individual patient basis.

Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene ® mesh. This technique has not been described before in the management of patients following wound dehiscence. KEYWORDSOpen abdomen -Laparostomy -Vacuum assisted wound closure Case HistoryWe describe the case of a 57-year-old woman with a background of asthma and obesity who was a heavy smoker. She presented to our clinic requesting a reversal of her ileostomy following a convoluted surgical history.The patient was originally referred to our hospital in December 2011 with a large umbilical hernia. On examination, however, a pelvic mass was found and urgent computed tomography (CT) was organised. Two weeks later she presented as an emergency with an acutely ischaemic leg and was transferred to the regional vascular centre. Revascularisation was unsuccessful and she underwent an above-knee amputation. Following the procedure, she developed peritonitis. CT showed a large ovarian mass and free gas so a laparotomy was performed. The findings were a right ovarian tumour adherent to the right colon, which was necrotic and perforated. A hysterectomy, bilateral salpingo-oophorectomy and right hemicolectomy were carried out. Primary anastomosis was felt to be too high risk so an end ileostomy and transverse colon mucous fistula were formed at separate sites. Histology showed a T1a ovarian tumour.The patient re-presented to our clinic requesting an ileostomy reversal. She was having significant problems with prolapse of the mucous fistula was unable to manage this. On examination, the prolapse was over 20cm. She also had a symptomatic incisional hernia. Owing to her ongoing symptoms and difficulty in managing the prolapse, the decision was made to go ahead with surgery.

This case demonstrates the successful treatment of a young female patient with colitis cystica profunda causing rectal prolapse, after primary treatment with a Delorme procedure had failed. An ultra-low anterior resection with a temporary defunctioning ileostomy was carried out with good postoperative results. This case illustrates the possibility of carrying out sphincter preserving surgery rather than an abdominoperineal resection in the treatment of this condition, which may be preferable for patients.