Seton techniques have been used in the successful management of fistula in ano for thousands of years. In particular, the cutting seton is useful for complex high anal fistula, and drainage setons may have a significant role in the treatment of sepsis related to Crohn's disease and in immunocompromised patients.

Although this procedure may not be appropriate for rectovaginal fistulas, the data suggest that cutting setons are effective in treating complex fistula-in-ano, including those that have failed to respond to other forms of surgery. Avoidance of preliminary internal sphincterotomy may prevent deterioration in continence.

Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch-rectal anastomosis should be avoided.

The role of laparoscopy in determining suitability for resection was prospectively evaluated in 244 patients with cancer of the gastric cardia and oesophagus. Laparoscopy enabled detection of inoperable disease in 92 patients (38 per cent), several of whom had more than one contraindication to surgery. Hepatic metastases (n = 75, 31 per cent), extensive peritoneal (n = 25, 10 per cent) or lymph node involvement (n =5, 2 per cent) and direct invasion of the liver or colon (n = 5, 2 per cent) were

HighlightsPneumatosis Intestinalis is a rare condition that may manifest with a wide range of symptoms from mild abdominal pain to acute peritonitis.In general, surgery is only indicated in symptomatic patients where medical therapy has failed and in patients presenting acutely unwell with a surgical abdomen.Treatment is generally medical and even with radiological evidence of perforation laparotomy may not be indicated if the patient is clinically well.Treatment with oxygen or hyperbaric oxygen has been shown to be effective.