Background This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (evidence grade: high or moderate).

The Enhanced Recovery After Surgery (ERAS) Group presents a comprehensive evidence-based consensus review of perioperative care for colorectal surgery. It is based on the evidence available for each element of the multimodal perioperative care pathway.

Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery.

Background: Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. Methods: Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan-Meier estimates were used to compare local recurrence. Results: In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7⋅6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2⋅4 years was 11⋅6 (95 per cent c.i. 6⋅6 to 19⋅9) per cent after TaTME compared with 2⋅4 (1⋅4 to 4⋅3) per cent in the NCCR (P < 0⋅001). The adjusted hazard ratio was 6⋅71 (95 per cent c.i. 2⋅94 to 15⋅32). Anastomotic leaks resulting in reoperation occurred in 8⋅4 per cent of patients in the TaTME cohort compared with 4⋅5 per cent in NoRGast (P = 0⋅047). Fifty-six patients (35⋅7 per cent) had a stoma at latest follow-up; 39 (24⋅8 per cent) were permanent.Conclusion: Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.

Objective

The incontinence rate after anatomic primary repair is low compared with the last decade's reported results after conventional primary repair. A short anal sphincter after repair is associated with a poorer outcome.

Background. Anal sphincter tears during vaginal delivery are a major cause of anal incontinence. We wanted to assess the incidence in a Norwegian county where primary repairs are performed in four hospitals using similar per-and postoperative protocol for the treatment of such injuries. Methods. A postal questionnaire was distributed to all women who underwent primary repair of obstetric sphincter tears in the years 1999 and 2000 in the county of Mö re and Romsdal. Symptoms of incontinence and fecal urgency were recorded. Incontinence was assessed using the Pescatori score system. Results. Clinically detected sphincter tears occurred in 180 of 5123 vaginal deliveries (3.5%). The questionnaire was returned by 156 women (87%). Six women were excluded. Median follow-up was 25 months (range 4-39). Incontinence was reported by 88 women (59%), restricted to flatus incontinence in 53 cases (35%). Fecal urgency without incontinence was reported by 14 women (9%). Sixty-three women (42%) reported de novo moderate to severe symptoms. There was no difference in outcome whether the sphincter injury was partial or complete. Mean Pescatori score was 3.7 in women who felt disabled compared with 2.9 in women who did not feel disabled by their incontinence (P < 0.001). Of 29 women who felt disabled, only three had sought medical attention. Fifty-eight women (39%) had received no information about the sphincter tear before discharge. Conclusion. Anal incontinence is common after both partial and complete obstetric sphincter tears. Information before discharge is deficient, and women avoid seeking medical attention when incontinence develops.

Background and Aims: asymmetric techniques for surgery in pilonidal sinus disease (psd) have been reported to provide better results than simple excision and closure in the midline. the aim of this retrospective study was to evaluate the results after introducing the Bascom asymmetric cleft lift procedure in our hospital on aday care basis.Material and Methods: from atotal of 33 patients operated from april 2002 to september 2004 with the Bascom asymmetric cleft lift technique, we were able to contact 29 who were invited to afollow up study.eighteen (62%) of these patients accepted aconsultation in the outpatient clinic while 11 (38%) were interviewed by phone.Results: at follow up mean 17 (range 10-27) months after the operation 24 (83%) of the wounds were healed while recurrences were present in 5(17%) of the patients. In two of the patients with recurrences errors in the procedures were identified. further results related to pre-, per-and postoperative conditions are discussed in this paper.Conclusion: early results after surgery for psd with the Bascom asymmetric cleft-lift technique are promising. the technique has now become our standard procedure for treating chronic, symptomatic psd.