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Five randomized controlled trials (RCTs) were identified and included in the final analysis with a total number of 611 patients randomized. Three hundreds and six patients were in the laparoscopic group and 305 patients in the open repair group. The range of follow up in the studies was two months to 35 months. The recurrence rate was similar (P = 0.30), wound infection was higher in the open repair group (P < 0.001), length of hospital stay was not statistically different (P = 0.92), and finally the operation time was longer in the laparoscopic group but did not reach statistical significance (P = 0.05) CONCLUSION: The short and long-term outcomes of laparoscopic and open abdominal wall hernia repairs are equivalent; both techniques are safe and credible and the outcomes are very comparable.

Surgical haemorrhoidectomy has a reputation for being a painful procedure for a fairly benign disorder. The circular transanal stapled technique for the treatment of haemorrhoids has the potential to achieve a less painful rectal procedure in place of ablative perianal surgery. We compared the short-term outcome of the circular stapled procedure for haemorrhoids with current standard surgery in a randomised controlled trial. Forty patients admitted for surgical treatment of prolapsing haemorrhoids were randomly assigned to Milligan-Morgan haemorrhoidectomy (n=20) or the circular stapled procedure. Under general anaesthesia patients underwent standardised diathermy excision haemorrhoidectomy or had a circumferential doughnut of rectal mucosa and submucosa above the dentate line excised and closed with a standard circular end-to-end stapling device. All patients received standardised preoperative and postoperative analgesic and laxative regimens. Patients completed linear analogue pain charts each day and were interviewed at 1, 3 and 6-10 weeks postoperatively. Summary measures of average pain experience were calculated from 10 cm linear analogue pain scores and were used as the primary outcome measure. The stapled group had shorter anaesthesia time (median 18 [range 9-25] vs 22 mins). Average pain in the stapled group was significantly lower than it was in the Milligan-Morgan group (2.1 [0.2-7.6] vs. 6.5 [3.1-8.5], 95.1% CI difference medians 1.9-4.7, p<0.00001. Mann-Whitney U test). Average pain relative to what the patient expected was also significantly less in the stapled group (-2.8 [-4.4 to 1.3] vs. 0·7 [-1.8 to 3.4]. Hospital stay and time to first bowel motion were not significantly different between groups. Return to normal activity was significantly shorter in the stapled group (17 [3-60] vs 34 . Early and late complications, patientassessed symptom control, and functional outcome appear similar after short-term follow-up. The circular stapled technique offers a significantly less painful alternative to Milligan-Morgan haemorrhoidectomy and is associated with an earlier return to normal activity. Early symptom control and functional outcome appear similar. However, long-term symptomatic and functional outcome need further study. Invited commentThis is one of the first papers published on a randomised trial comparing stapled procedure versus Milligan-Morgan for haemorrhoids. Twenty patients were included in both arms and were operated in general anesthesia with identical premedications, postoperative drugs as well as standard postoperative nursing care. Patients were not aware of which procedure they underwent. The primary outcome measure was postoperative pain. Secondary out-come measures were expected pain, anaesthesia time, use of analgesia, time to first bowel motion and time until return to normal activity.Patients had to register daily using an analogue scale if the pain they experienced was better or worse to what they had expected. Pain is a very subjective feeling and haemorrhoidectomy has a b...

Treatment strategies for metastatic colorectal cancer (mCRC) patients have undergone dramatic changes in the past decade and despite improved patient outcomes, there still exist areas for continued development. The introduction of targeted agents has provided clinicians with additional treatment options in mCRC, however, results have been mixed at best. These novel therapies were designed to interfere with specific molecules involved in the cellular carcinogenesis pathway and ultimately deliver a more focused treatment. Currently, their use in mCRC has been limited primarily as an adjunct to conventional chemotherapy regimens. This review explores the relevant cell-signaling networks in colorectal cancer, provides focus on the current targeted agent armamentarium approved for use in mCRC and explores the usefulness of predictive mCRC biomarkers.