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Highlights Anatomical variations in the RHA may concern its number, origin or route. A prebiliary course of the RHA has been described with a prevalence ranging from 15 to 25%. CT Angiography is the exam of choice to establish a complete vascular mapping. The RHA remains an essential anatomical landmark that all surgeons must keep in mind in order to avoid any unfortunate incidents.

Purpose Immediate coloanal anastomosis (ICA) remains the standard technique for restoring the digestive tract after proctectomy for low rectal cancer. Often, it requires a temporary diversion stoma, thus increasing the risk of complications. Recent data have shown a great potential of the delayed coloanal anastomosis (DCA) both in decreasing anastomosis morbidity and in avoiding ileostomy to the patients. More recently, a modified delayed coloanal anastomosis (mDCA) has been described and seems to have promising results. This study aims to determine whether mDCA is non-inferior to ICA. Methods The IMODE trial is a randomized, controlled, non-inferiority trial designed to enroll 70 adults with mid or low rectal cancer. Participants are randomized to ICA or mDCA. The primary endpoint is the anastomotic fistulas (AF) rate at 6 months. Conclusions The mDCA can constitute an interesting modality to restore the digestive tract following proctectomy for mid and low rectal cancer; this by decreasing the morbidity of the coloanal anastomosis on the one hand and by avoiding ileostomy on the other hand. Trial registration PACTR202209500145137, September 9th, 2022 (retrospectively registered).

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<p><strong>Background:</strong> Several Western studies support the idea that some acute appendicitis (AA) can be successfully treated by antibiotics. The rationale for the non-operative treatment is essentially based on the non-futility of the vermicular appendix which seems to play a major role in the pathophysiology of the digestive tract. However, this approach still suffers from a failure rate of around 20-30% in the first year, rising to nearly half of patients within 5 years. In Algeria, appendectomy is still the standard of care. Through rigorous selection, the Kouba non operative management of acute appendicitis (KNOMA) trial aims to determine whether non-operative treatment (NOT) is non-inferior to surgery.</p><p><strong>Methods:</strong> KNOMA is a randomized, controlled, non-inferiority trial designed to enroll 180 adults with CT-confirmed uncomplicated AA. Participants are randomized to appendectomy or 9 days of antibiotics (Abx). The primary endpoint is the failure rate at 12 months. This trial was designed to take into account the specifics of the Algerian population and practices in Algeria.</p><p><strong>Conclusions:</strong> This is the first trial in Africa and middle-income countries to evaluate the comparative efficacy of antibiotics and appendectomy for the treatment of CT-confirmed uncomplicated acute appendicitis based on failure rate assessment.</p><p><strong>Trial registration:</strong> This trial was registered on pactr.org on 28 March 2022 (PACTR202203751640059).</p>