Fast-track is a safe and effective approach for reducing hospital stay and morbidity following major colonic surgery.

The most common reason for missed tumours was technical. The percentage of missed tumours in each region of the bowel correlates with the known incidence of tumours in each region and with a normal Dukes stage distribution, except in the caecum where the number of missed lesions was higher than expected.

The phenomenon of strictures of the colon induced by nonsteroidal anti-inflammatory drugs is a newly recognized pathologic entity that has gained little exposure in the surgical literature to date. A further case is reported and the clinical features of this entity are discussed. Most patients present with symptoms suggestive of malignancy, namely anemia, obstructive symptoms, or weight loss. Pathologic changes are characterized by diaphragm-like strictures with submucosal fibrosis. Surgical resection to exclude malignancy and treat symptoms along with cessation of the nonsteroidal anti-inflammatory drug is the treatment of choice.

Background Defunctioning loop ileostomies (DLIs) are a frequent adjunct to rectal cancer surgery. Delayed closure of DLIs is common and associated with increased morbidity. The reasons for delayed DLI closure are often unknown. The economic burden of delayed DLI closure is not quantified. The present study aimed to determine the reasons for, and economic burden of, delayed DLI closure. Methods Clinical and economic data were audited from a prospective database of patients in two Australasian colorectal cancer centres. Patients treated at each unit with low/ultra‐low anterior resection for rectal cancer with formation of DLI between January 2014 and December 2019 were included. Post‐operative complication rate, stoma‐related complication rate and costs of hospital admissions and stoma care were recorded and analysed. Multivariate linear regression analysis was used to investigate risk factors for delay to closure. Results 146 patients underwent low/ultra‐low anterior resection with DLI; 135 patients (92.5%) underwent reversal. The median duration to reversal was 7 months (IQR 4.5–9.5). Sixty‐six percent of patients underwent reversal >6 months after their index surgery. Neoadjuvant and adjuvant chemotherapy were associated with delayed reversal (P < 0.001). Non‐English speakers waited longer for DLI closure (P = 0.028). The costs of outpatient stoma care (P < 0.001), post‐operative care (P = 0.004), and total cost of treatment (P = 0.014) were significantly higher in the delayed closure group, with a total cost of treatment difference of $3854 NZD per patient. Conclusions Causes of delay include systemic factors and demographic factors that can be addressed directly, addressing such causes may alleviate a significant economic burden.

Purpose  Fast‐Track Surgery or Enhanced Recovery After Surgery (ERAS) programs are becoming increasingly common. However there are concerns regarding safety, readmission rates and the impact on overall morbidity. We aimed to compare the results from our ERAS program for elective colonic surgery with those from our institution prior to commencement of ERAS. Method  We established an ERAS program for colonic resection at Manukau Surgical Centre (MSC) in Auckland. This included strategies such as epidural analgesia, early feeding and mobilisation. Patients were discharged once they were able to tolerate a full diet, had evidence of return of GI function and pain was managed with oral analgesia. They were followed up within a week. Results  From Dec 2005 to Dec 2006, 35 consecutive patients undergoing elective colonic resection at MSC under our ERAS program were studied prospectively. The control group consisted of 35 consecutive patients undergoing colonic resection under conventional care at the same institution prior to Dec 2005. Groups were comparable with respect to physiological and operative CR‐POSSUM scores. Median day stay for the ERAS group was 4 (3–27) compared to 8 (4–30) days for the conventional group (p < 0.001). ERAS was associated with a trend towards an earlier return of gastrointestinal function, reduced rate of infective and pulmonary complications. There were no differences in the readmission rates. Conclusion  ERAS is a practical and safe method of managing patients undergoing major colonic surgery and such structured care plans not only reduce hospital stay but may also be associated with reduced immediate post‐operative morbidity.