Clinical function and anorectal physiology were studied prospectively in patients with rectal cancer after low anterior resection, randomized to either a straight anastomosis or an 8-cm colonic J pouch anastomosis. Sixteen patients (mean(s.e.m.) age 61.2(3.2) years; ten men, six women) had a straight anastomosis and 17 (mean(s.e.m.) age 61.2(3.8) years; six men, 11 women) a colonic pouch anastomosis. At 1 year after low anterior resection, a bowel function questionnaire was administered and anorectal physiology tests were performed. Patients with a straight anastomosis had significantly more frequent stools (median 6 (range 3-7) daily) compared with those who had a pouch (median 3 (range 2-7) daily; P = 0.02). A frequent sensation of incomplete defaecation was found in three patients with a straight anastomosis compared with ten who had a pouch anastomosis (P = 0.02). The mean resting anal pressures were lower after colonic pouch anastomosis (P = 0.049) but there were no differences in anal squeeze pressure, rectal sensation, volume of first sensation and compliance between the two groups. The decreased stool frequency with an 8-cm colonic pouch was not associated with measured improvements in rectal reservoir function. It is possible that reversed propulsive activity may be important in smaller colonic J pouches.

BackgroundThe World Health Organization Surgical Safety Checklist (SSC) has been widely implemented in an effort to decrease surgical adverse events.MethodThis systematic literature review examined the effects of the SSC on postoperative outcomes. The review included 25 studies: two randomised controlled trials, 13 prospective and ten retrospective cohort trials. A meta-analysis was not conducted as combining observational studies of heterogeneous quality may be highly biased.ResultsThe quality of the studies was largely suboptimal; only four studies had a concurrent control group, many studies were underpowered to examine specific postoperative outcomes and teamwork-training initiatives were often combined with the implementation of the checklist, confounding the results. The effects of the checklist were largely inconsistent. Postoperative complications were examined in 20 studies; complication rates significantly decreased in ten and increased in one. Eighteen studies examined postoperative mortality. Rates significantly decreased in four and increased in one. Postoperative mortality rates were not significantly decreased in any studies in developed nations, whereas they were significantly decreased in 75 % of studies conducted in developing nations.ConclusionsThe checklist may be associated with a decrease in surgical adverse events and this effect seems to be greater in developing nations. With the observed incongruence between specific postoperative outcomes and the overall poor study designs, it is possible that many of the positive changes associated with the use of the checklist were due to temporal changes, confounding factors and publication bias.

The large circular anal dilator used for stapled haemorrhoidectomy increased the risk of anal sphincter injuries, which may become problematic with ageing.