Laparoscopic-assisted resection of right-sided colonic cancer has the advantage over open surgery in allowing earlier recovery. However this is at the expense of a longer operating time and higher direct cost (registration number: NCT00485316 ( http://www.clinicaltrials.gov )).

INTRODUCTIONWhen not diagnosed early and treated promptly, pyogenic liver abscess can be fatal, with reported mortality rates as high as 80%-100% [1] . Historically, the treatment of choice for pyogenic liver abscess had been open surgical drainage [2] . However, with the advent of minimally invasive therapy such as image-guided percutaneous needle aspiration or catheter drainage and the availability of broadspectrum antibiotics, patients with pyogenic liver abscess nowadays seldom require open surgery for treatment [3,4] . We aim to evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. MATERIALS AND METHODSBetween January 1995 and December 2002, one hundred patients with pyogenic liver abscess were treated at our institution. Among them, thirteen patients required open surgical treatment. The medical records of these thirteen patients were retrospectively reviewed to determine the demographic data, clinical presentation, indications and nature of surgery, and outcome of surgery.The diagnosis of pyogenic liver abscess was established by a combination of clinical, radiological, operative, and/ or microbiological findings. All patients with suspected Abstract AIM: To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy.

Background: Post-haemorrhoidectomy wound pain is often the focus of concern for patients as well as their clinicians. Despite the recent enthusiasm brought about by stapled haemorrhoidectomy, conventional haemorrhoidectomy still remains the mainstay of surgical treatment for symptomatic third and fourth degree haemorrhoids in places where healthcare funding cannot afford these expensive devices. The present study aims at evaluating the effectiveness of pre-emptive analgesia and oral metronidazole in reducing wound pain and complications after open haemorrhoidectomy. Method: Patients with symptomatic third or fourth degree haemorrhoids undergoing open haemorrhoidectomy were randomized into four groups. Group 1 received pre-emptive analgesia (0.5% bupivacaine). Group 2 received oral metronidazole (400 mg three times daily for 1 week). Group 3 received both treatments while group 4 was the control group. Results: Number of patients recruited was 105. There was no significant difference among the four groups in terms of pain scores on the first three postoperative days, analgesic requirements, hospital stay and the time to return to normal daily activities. Patients who received oral metronidazole had significantly less pain at the time of the first bowel motion (P = 0.037). Conclusion: Oral metronidazole significantly reduces pain during the first bowel motion after open haemorrhoidectomy. Pre-emptive analgesia with 0.5% bupivacaine does not reduce postoperative pain.

Objective: Postoperative adhesive intestinal obstruction is the most common cause of small bowel obstructions in adults. The use of water-soluble contrast follow-through has been shown to be safe with a high predictive value for surgery. This study aims to evaluate the impact of contrast follow-through on clinical outcomes of patients with adhesive small bowel obstructions. Methods: From July 1994 to June 1998, 150 patients were recruited into the study and randomized into two groups. One group ( n = 75) received water-soluble contrast follow-through within 24 h of admission, whereas the control group ( n = 75) did not. Both groups were put on conservative management and the outcomes measured included operative rate, postoperative morbidities, length of hospital stay and mortality. Results: The operative rate of both groups was similar (33.3 vs 38.7%, P = 0.496). The preoperative observation period (42 vs 65 h. P = 0.014) and the total median hospital stay (5 vs 7 days, P = 0.025) of the contrast group were significantly shorter than those of the control group. No significant difference could be found between the two groups in terms of postoperative morbidities and mortalities. Conclusions: In managing patients suspected to have adhesive small bowel obstruction, water-soluble contrast follow-through expedites the decision process for surgical intervention, which translates into a shorter hospital stay.

Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and fewer male sexual problems when compared with open surgery in Chinese patients. These findings, however, should be interpreted with caution because of the small sample size of the study.

MRC is useful for detection of colonic pathology and assessment of proximal colon in patients with colonic cancer after incomplete colonoscopy.

Telerobotic surgery is the most advanced development in the field of minimally invasive surgery. The da Vinci surgical system, which is currently the most widely used telerobotic device, was approved by the Food and Drug Administration of the United States of America for clinical use in all abdominal operations in July 2000. The first da Vinci surgical system in China was installed in November 2005 at our institution. We herein report the first telerobotic-assisted laparoscopic abdominoperineal resection using the 3-arm da Vinci surgical system for low rectal cancer in Hong Kong and China, which was performed in August 2006. The operative time and blood loss were 240 min and 200 mL, respectively. There was no complication, and the patient was discharged on postoperative day five. An updated review of published literature on telerobotic-assisted colorectal surgery is included in this report, with special emphasis on its advantages and limitations.

Hepatic venous outflow obstruction after piggyback liver transplantation is a very rare complication. An unusual mechanism aggravating it is reported. A 33-year-old man with end-stage hepatitis B liver cirrhosis underwent a piggyback orthotopic liver transplantation using a full-size cadaveric graft. Two months after transplantation, he developed gross ascites refractory to maximal diuretic therapy. Doppler ultrasound showed patent portal and hepatic veins. Serial computed tomography scans revealed a hypoperfused right posterior segment of the liver which subsequently underwent atrophy. Hepatic venography demonstrated a high-grade stenosis with an element of torsion of venous drainage at the anastomosis. The stenosis was successfully treated with repeated percutaneous balloon angioplasty. The patient remained asymptomatic six months afterwards with complete resolution of ascites and peripheral edema. We postulate that liver allograft segmental hypoperfusion and atrophy may aggravate or result in a hepatic venous outflow problem by the mechanism of torsion effect. Percutaneous balloon angioplasty is a safe and effective treatment modality for anastomotic stenosis.