Our experience suggests a potential role for endovascular therapy of celiac and mesenteric arterial occlusive disease in a variety of clinical scenarios, with a low incidence of complications and a high technical success rate.

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Incisional negative pressure wound therapy appears to reduce surgical site infection in open colorectal surgery. Further study may be helpful to identify patient populations who would have the greatest benefit from this technique(see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A115).

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Many tests are available to assist in the diagnosis and management of fecal incontinence. Imaging studies such as endoanal ultrasonography and defecography provide an anatomic and functional picture of the anal canal which can be useful, especially in the setting of planned sphincter repair. Physiologic tests including anal manometry and anal acoustic reflexometry provide objective data regarding functional values of the anal canal. The value of this information is of some debate; however, as we learn more about these methods, they may prove useful in the future. Finally, nerve studies, such as pudendal motor nerve terminal latency, evaluate the function of the innervation of the anal canal. This has been shown to have significant prognostic value and can help guide clinical decision making. Significant advances have also happened in the field, with the relatively recent advent of magnetic resonance defecography and high-resolution anal manometry, which provide even greater objective anatomic and physiologic information about the anal canal and its function.

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Surgery for rectal cancer has advanced greatly over the past decade. Our knowledge of total mesorectal excision has led to improved oncologic outcomes. The concept of extralevator abdomino-perineal resection shows promise for reducing recurrence rates in tumors of the low rectum and anal canal. Once popular, local excision of rectal tumors has now been shown to have largely unacceptable recurrence rates. Minimally invasive techniques of laparoscopic and robotic surgery are technically feasible, and promise decreased complications in the future. Finally, new colonoscopic and endoscopic techniques offer alternatives for those unfit for surgery.