Complex robotic colorectal surgery can be performed early in the experience, with reduced operative time. Overall complications are reduced after 15 robotic cases. This study shows that improvement in robotic surgery operating time and surgical outcomes occur along with application of the technology to more difficult cases, not as a function of choosing less complex cases.

In the long term following spinal cord injury, bowel dysfunction causes major physical and psychological problems. A retrospective review of intestinal stomas performed in patients with spinal cord injury over a 10 year period was performed to investigate their role in alleviating these problems. Twelve patients underwent left iliac fossa end colostomy and two patients right iliac fossa end ileostomy. The mean age of patients at operation was 54.8 years (20 ± 65), and the mean time from injury to stoma formation was 15 years (2 ± 37). The mean period of unsatisfactory bowel management before stoma formation was 5.4 years (1.5 ± 25). Following colostomy the mean time spent on bowel care per week fell from 8.8 h (0.6 ± 12.2) to 1.4 h (0.3 ± 3.5) and independence in bowel care rose from 50 to 92%. All patients stated that their bowel care was easier and 83% said their independence had increased. Ninety-two per cent wished colostomy had been o ered earlier and no patient undergoing colostomy wanted it reversed. The most common complication following colostomy was exclusion colitis. The mean time of follow-up post colostomy formation was 38 months (7 ± 130). Formation of an intestinal stoma is a safe, e ective and well accepted treatment for selected patients with intractable problems of bowel management following spinal cord injury.

Endosonography after sphincteroplasty can identify residual sphincter defects that are significant in terms of fecal continence. Restoration of anal canal resting and squeeze pressures was related to improved fecal control after overlapping sphincteroplasty. Mean pudendal nerve terminal motor latency was not significantly related to poor postoperative continence. A trend toward less improvement in fecal continence was noted with bilateral pudendal neuropathy.

Stage III patients were less likely to be in the complete pathologic response group than Stage II patients. Complete pathologic response patients were less likely to receive postoperative adjuvant chemotherapy than noncomplete pathologic response patients. Complete pathologic response after neoadjuvant chemoradiation for rectal cancer patients demonstrated a trend toward improved survival and decreased recurrence compared with noncomplete pathologic response patients.

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