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Recent improvements in the outcome for low rectal cancer have focused on the reconstruction of the perineal defect following greater acceptance of the need for a wider perineal excision encompassing the levator ani complex. In this article we look at the use of biologic materials to close the perineal defect and compare this with the use of other techniques.

The pilot 'Be Clear on Cancer' awareness campaign had a significant effect on the number of patients being referred from GPs to hospital; however, the effect was short lived and had returned to baseline by 3 months. The campaign had no effect on the number of new cancers diagnosed, which was the stated underlying aim of the pilot.

Patients with locally advanced and recurrent cancer involving the lateral pelvic sidewall may be rendered suitable for potentially curative radical resection with a modification in the approach to the lateral pelvic sidewall. Our pilot series seems to indicate that our novel technique (ELSiE) is feasible, safe and yields high rates of complete pathological resection.

The consensus process has provided guidance for the management of patients with PRC-bTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.

However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery. METHODS A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners. RESULTS The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion. CONCLUSIONS The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.In the UK, laparoscopic colorectal surgery is increasing. Nevertheless, a substantial proportion of surgery remains open.1 The accepted 'gold standard' technique for postoperative analgesia following open colorectal surgery is epidural analgesia (EA).2 The use of EA provides effective analgesia, and has the benefits of reducing systemic opiate requirements, ileus and pulmonary complications.3,4 Epidurals have reported complications that range from superficial wound site infection to paraplegia. 5-8The introduction of local nerve blocks in place of EA in open colorectal surgery has shown promising results.9,10 The use of regional blocks has been shown to provide effective postoperative analgesia and demonstrates opiate sparing properties. Furthermore, it has been shown to be safe and avoids the risk for potentially devastating complications of EA. Associated complications with the use of regional blocks include insufficient block, local anaesthetic toxicity and visceral puncture. However, the safety margin can be improved by the use of ultrasonography to guide insertion.11 A study looking at the opiate sparing effects of regional block (transverse abdominis plane) for right hemicolectomies has produced promising results. 12We aim to add to this body of evidence and expand on it by describing the analgesic effect of ultrasonography guided rectus sheath catheters (RSCs) compared with EA in op...

The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.