INTRODUCTIONFaecal incontinence (FI) is frequently referred to as a 'silent epidemic', explaining the inherent difficulty in obtaining reliable data that is reflective of the study population. FI is a socially stigmatised condition that is extremely distressing to its sufferers, and a cause of both physical and psychological morbidity. While sufferers from all age groups have been reported, FI is known to predominantly affect the elderly.(1) The predicament of this group of patients is worsened by the embarrassment associated with the condition and the lack of public education, both of which result in patients suffering in silence instead of seeking appropriate medical treatment.Previous population studies have faced criticisms related to the variable definitions of FI, the use of non-validated assessment tools, poor response rates and nonrepresentative populations that are unable to reflect the true prevalence of FI in the general population.(1-3) These issues largely stem from a lack of consensus regarding the definition of FI and the appropriate assessment tools, as well as difficulties faced when trying to administer these assessment tools to the appropriate study population (given the sensitive nature of the condition). Previous studies have reported a wide range of prevalence rates of FI within the general population (0.8%-18.0%).(1-3) Moreover, the inconsistent definition of FI -defined as the involuntary loss of control over the release of solid stools, liquid stools and/or gas -has accounted partly for the wide ranging prevalence rates in the aforementioned studies.The primary objectives of the present study were to determine the prevalence of FI in the general Singapore population and to identify possible at-risk groups. It is our hope that this study, the first of its kind in Singapore, will give us valuable insight into this often neglected but significant condition in the local context, as well as enable healthcare administrators to more efficiently allocate the necessary resources to meet the needs of these vulnerable subgroups of patients. METHODSWe identified a minimum sample size of 380 subjects for this study, based on a 10% estimated prevalence of FI in the general population and a 3% (95% confidence interval) margin of error. Via a computer-generated number allocation system, 1,000 subjects above the age of 21 years were randomly selected from the national electoral roll. In view of the prevailing data that women are at risk of developing FI, (4,5) we sampled 500 subjects from each gender (i.e. gender-stratified sampling was performed) to reduce sampling bias.The primary component of the questionnaire used was the Comprehensive Fecal Incontinence Questionnaire (CFIQ), a validated and reliable assessment tool designed and tested in the general population of Auckland, New Zealand, by Macmillan et al. The CFIQ assesses both the severity of FI and its impact on quality of life. In addition, to assess whether the subjects perceived that they were suffering from a bowel control problem, the CFIQ in...

Close distal resection margins do not negatively impact long-term disease control, even without the use of neoadjuvant therapy, provided that safe, optimal surgical resection is performed. Circumferential radial margin may be a more important indicator for outcomes.

Introduction Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short‐term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02–2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10–7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non‐transanal laparoscopic TME. However this association was lost in the mixed‐effects model controlling for patient and disease factors (OR 1.23, 0.77–1.97, P = 0.39 and OR 2.11, 0.79–5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55–4.77, P < 0.001) and male gender (OR 2.29, 1.52–3.44, P < 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%. Conclusion This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.

Introduction The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre‐operative imaging. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post‐treatment MRI restaging (yMRI) and final pathological staging. Results Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post‐treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T‐stage, N‐stage, or AJCC status were each graded as ‘fair’ only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively). Conclusion The reported pCR rate of 10% highlights the potential for non‐operative management in selected cases. The limited strength of agreement between basic conventional post‐chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.

An intramesosigmoid hernia is 1 of the 3 rare types of sigmoid-related hernias that could be complicated by intestinal obstruction. Our patient presented with a clinical picture of intestinal obstruction. CT scan showed features of strangulated small-bowel obstruction secondary to a sigmoid-related hernia. This was confirmed intraoperatively to be an intramesosigmoid hernia. We share the radiological findings with intraoperative surgical correlation and discuss the imaging features described in the literature.