No abstract

The GSTP1 level is increased in rectal adenocarcinoma compared with adjacent normal mucosa. It decreases following neoadjuvant therapy. Future studies correlating pre-therapy GSTP1 levels with pathological response would be of interest.

Aims: The use of a loop ileostomy is an effective method to protect pelvic anastomoses. Its use has increased recently, although there is some debate as to the routine use of a stoma. A second operation is required to close the stoma, with potential complications. The aim of this study was to assess prospectively the morbidity of closure of loop ileostomy. Methods: All patients scheduled for loop ileostomy closure over a 12‐month period were included. The operative technique, complications and length of stay were recorded. Results: A total of 50 consecutive patients (28 male, 22 female) with a median age (interquartile range, IQR) of 56 years (42–73) underwent ileostomy closure, at a median time (IQR) of 28 weeks (18–48) after formation. Twenty‐four (48 per cent) were formed after low anterior resection for carcinoma, 20 (40 per cent) after ileal pouch anal anastomosis for ulcerative colitis and 6 (12 per cent) after other procedures. Thirty‐eight (76 per cent) had a stapled closure and 12 (24 per cent) sutured. Twelve patients (24 per cent) developed complications; 6 (12 per cent) had intestinal obstruction of which one required a laparotomy, 4 (8 per cent) had wound infections of which one required re‐operation, 1 (2 per cent) had an ileal anastomotic leak and subsequently died and 1 (2 per cent) died from a myocardial infarction. The median length (IQR) of hospital stay was 8 days (7–10). Conclusions: We have demonstrated that a quarter of patients develop complications after loop ileostomy closure. The majority of these are minor. Methods to reduce the number of complications, such as optimum time to closure and distal limb irrigation techniques, need to be studied.

Aims: Incontinence scores are used to quantify faecal incontinence and allow comparison between patients. Anorectal manometry is routinely used for the assessment of incontinence. Patients with mild incontinence often have normal results. We have reported the measurement of RPG in the assessment of incontinence. This study examined the role of this technique in patients with varying degrees of incontinence. Methods: Patients referred for anorectal investigations were recruited. Patients completed a Wexner incontinence score (WIS). Patients were grouped by incontinence score: continent (WIS 0, n = 37), mildly incontinent (WIS 1–7, n = 29), moderately incontinent (WIS 8–13, n = 34) and severely incontinent (WIS 14–20, n = 16). Patients underwent standard anorectal manometry. The following manometric measurements were recorded: maximum mean resting pressure (MMRP), maximum mean squeeze pressure (MMSP), vector volume (VV) and resting pressure gradient (RPG). The Mann–Whitney U‐test was used to analyse results. Results: A total of 116 patients were recruited into the study [92 females, 24 males: median age 51 (interquartile range 37–67) years]. Each measurement was compared between the continent group and: (a) all incontinent patients (b) moderately and severely incontinent patients and (c) mildly incontinent patients. Discussion: This study shows that RPG is an early indicator of faecal incontinence. Standard measurements of MMRP, VV and MMSP are often normal in patients with mild incontinence and only become significantly lower in patients with at least moderate symptoms. We recommend the routine use of RPG in the manometric assessment of faecal incontinence.