Background: Anastomotic leak is a common complication after colorectal surgery, associated with increased morbidity and mortality, and poorer long-term survival after oncological resections. Early diagnosis improves short-term outcomes, and may translate into reduced cancer recurrence. Multiple studies have attempted to identify biomarkers to enable earlier diagnosis of anastomotic leak. One study demonstrated that the trajectory of C-reactive protein (CRP) levels was highly predictive of anastomotic leak requiring intervention, with an area under the curve of 0⋅961. The aim of the present study was to validate this finding externally. Methods: This was a prospective international multicentre observational study of adults undergoing elective colorectal resection with an anastomosis. CRP levels were measured before operation and for 5 days afterwards, or until day of discharge if earlier than this. The primary outcome was anastomotic leak requiring operative or radiological intervention. Results: Between March 2017 and July 2018, 933 patients were recruited from 20 hospitals across Australia, New Zealand, England and Scotland. Some 833 patients had complete CRP data and were included in the primary analysis, of whom 41 (4⋅9 per cent) developed an anastomotic leak. A change in CRP level exceeding 50 mg/l between any two postoperative days had a sensitivity of 0⋅85 for detecting a leak, and a high negative predictive value of 0⋅99 for ruling it out. A change in CRP concentration of more than 50 mg/l between either days 3 and 4 or days 4 and 5 after surgery had a high specificity of 0⋅96-0⋅97, with positive likelihood ratios of 4⋅99-6⋅44 for a leak requiring intervention. Conclusion: This study confirmed the value of CRP trajectory in accurately ruling out an anastomotic leak after colorectal resection.

Aim Postoperative pain remains a major factor in recovery from colorectal resection. There is increasing interest in opioid‐sparing analgesia, and intraperitoneal local anaesthetic (IPLA) has recently been shown to be useful in minor laparoscopic and open colorectal procedures. The aim of this study was to evaluate the impact of IPLA on functional recovery following major laparoscopic surgery. In this controlled trial, mobility, as measured by the De Morton Mobility Index (DEMMI), was used as a surrogate for postoperative functional recovery. Method Patients undergoing laparoscopic colorectal resection were randomized either to continuous ropivacaine (0.2% at 4–6 ml/h) or to saline (0.9%) which were administered via intraperitoneal catheter for 3 days postoperatively. Results were analysed in a double‐blind manner. DEMMIs were assessed on postoperative days 1, 2, 3, 7 and 30, and data on pain, opioid consumption, gut and respiratory function, length of stay (LOS) and complications were recorded. Results Ninety‐six patients were recruited. There was no difference in primary outcome (i.e., functional recovery) between IPLA and placebo groups. Opioid consumption and LOS were similar between groups, and no differences were found for any secondary outcome measure. There were no adverse events related to ropivacaine. Conclusion Infusional intraperitoneal local anaesthetic appears to be safe but does not improve functional recovery or analgesic consumption following elective laparoscopic colorectal surgery, in the setting of an established enhanced recovery programme.

What does this paper add to the literature? This survey of Australian and New Zealand surgeons examines the use of diverting ileostomies in two common scenarios along with the use of both transanal tubes and pelvic drains.

The yield of a second colonoscopy within 5 years of a good-quality negative colonoscopy is low but not zero. In the absence of new concerning symptoms or other risk factors, patients can be reassured and guidelines adhered to.

BACKGROUND:There is much debate surrounding the ideal antiseptic skin preparation agent to reduce postoperative surgical site infection. International guidelines suggest that chlorhexidine-and alcoholcontaining compounds have superior efficacy. However, there are minimal clinical trials specifically looking at skin preparation agents for colorectal surgery. OBJECTIVE:The aim of this study was to compare the efficacy of chlorhexidine in alcohol versus povidoneiodine in alcohol versus povidone-iodine in aqueous solution for the prevention of surgical site infection in colorectal surgery.