Background: Definitive closure of fistula-in-ano poses an ongoing surgical challenge. The OVESCO OTSC ® Proctology Clip (proctology clip) purports to offer improved preservation of the anal sphincter whilst at the same time curing the fistula by closure. Methods: A retrospective record review was conducted for patients who received the proctology clip as part of the management of fistula-in-ano in the Colorectal Unit at Wits Donald Gordon Medical Centre (WDGMC). Results: There were 19 cases of fistula-in-ano treated with the proctology clip. All were cryptoglandular in origin. The median age was 50 years (IQR 44-56 years) and post-procedure, the median follow-up duration was 145 days (IQR 63-298 days). Overall, 9 procedures were successful (47%). Success rates were higher for simple (66.7%) as opposed to complex (38.5%) fistula-in-ano. For patients who underwent placement of the proctology clip as a primary procedure, the success rate (50%) was slightly better than those who received the clip as a secondary procedure (44.4%). Conclusion:This preliminary data presents our initial experience using the proctology clip. While these data may serve as a "proof of concept", a multi-centre controlled trial comparing this method to the rectal mucosal advancement flap (RMAF) is needed to determine the role of the proctology clip in the management of fistula-in-ano.

Colonoscopy is regularly used for investigation of bowel pathology and has become the gold standard for screening and diagnosis of colorectal cancer (CRC). [1] The procedure has diagnostic and therapeutic benefits, such as direct visualisation of the entire colon and removal of precancerous polyps, which is associated with a lowered risk of CRC. [2] Colonoscopy is a skill-intensive procedure and poses a risk to the patient, even if performed by a trained endoscopist in an appropriate setting. [1] Therefore, there is a need for standardised practice and regular audit of endoscopists to ensure consistent, high-quality care. [3] Based on the 'adenoma-carcinoma sequence' hypothesis for developing CRC, screening and surveillance colonoscopy aim to detect and remove polyps, particularly adenomatous polyps, with the intention of reducing the incidence of CRC. [4] Therefore, the polyp detection rate (PDR) and adenoma detection rate (ADR) are two key indicators of the quality of endoscopy. Other measurable This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

According to GLOBOCAN, colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancerrelated death, with 1.85 million new cases diagnosed worldwide in 2018. [1,2] The incidence of CRC appears to be increasing in emerging low-and middle-income countries (LMICs) owing to socioepidemiological transitions, including dietary changes, with countries in sub-Saharan Africa (SSA) reporting a notable increase in colorectal, breast and prostate cancer. [3,4] South Africa (SA) is no exception-the incidence of CRC is increasing steadily, and it was the sixth leading cause of cancer-related death in 2018. [1] It is noteworthy that apart from increasing incidence, the average age of CRC patients at the time of diagnosis in SSA is ~10 years younger than that observed in high-income countries (HICs). [5,6] In addition, other non-communicable diseases (NCDs), including diabetes and respiratory and cardiovascular disease, are on the rise, with the prevalence in SA being reported as two to three times higher than in HICs. [7] While there are no published data on comorbidity with CRC from SSA, many CRC cohorts from HICs describe a considerable comorbidity burden that adversely affects short-(30-day) and long-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Background: Colorectal surgery has developed into an established surgical subspecialty in South Africa, however there is a paucity of data regarding the epidemiology and surgical outcomes of patients with colorectal disease in this country. The objective is to present the findings of a one-year audit of the Wits Donald Gordon Medical Centre (WDGMC) Colorectal Unit with specific reference to indications, surgical procedures and patient outcomes. Methods: Patient files from December 2016 to November 2017 were included in a retrospective analysis. The Mann-Whitney U test was used to analyse continuous variables and the Chi-squared test was used to compare categorical variables. Results: During the audit period, 1264 patients were admitted to the Colorectal Unit and a further 564 outpatient endoscopic procedures were performed. There were 306 emergency admissions. 139 elective colorectal resections took place, with a 16% major complication rate, a 12% anastomotic leak rate and no deaths. Rectal resections constituted 66% of the operations and 34% were colonic resections. The median length of stay for all patients undergoing resection was 9 days and there was no statistically significant difference in length of stay between open and laparoscopic cases. Conclusion: The WDGMC Colorectal Unit manages a high volume of patients presenting with the full spectrum of colorectal disease.