Aim: To investigate genotype-phenotype correlations in patients with perianal Crohn’s disease (PCD) in order to determine which factors predispose to development of perianal disease in Crohn’s patients. Methods: Seven-hundred and ninety-five Caucasian individuals (317 CD patients and 478 controls without inflammatory bowel disease, IBD) were prospectively enrolled into a clinical/genetic database. Demographic and clinical data, as well as peripheral blood leukocyte DNA were obtained from all patients. The following were evaluated: three NOD2/CARD15 polymorphisms: R702W, G908R, and 1007insC; five IL-23r risk alleles: rs1004819, rs10489629, rs2201841, rs11465804, and rs11209026; a well-characterized single-nucleotide polymorphism (SNP) on the IBD5 risk haplotype (OCTN1) and two peripheral tag SNPs (IGR2060 and IGR3096). Results: PCD occurred in 147 (46%) of CD patients. There was no significant difference in the age at disease diagnosis between non-PCD and PCD patients (33 vs. 29 years, respectively). PCD patients were more likely to have disease located in the colon and ileocolic regions (79 PCD vs. 57% non-PCD; n = 116 vs. n = 96; p < 0.001), whereas patients with non-PCD were more likely to have Crohn’s within the terminal ileum and upper gastrointestinal tract (43% non-PCD vs. 21% PCD; n = 73 vs. n = 31; p < 0.05). Thirty-four percent of patients with PCD required a permanent ileostomy (n = 50) compared to only 4% of non-PCD patients (n = 6; p < 0.05). Mutations in CARD15/NOD2 and IL-23r were risk factors for CD overall; however, in contrast to prior reports, in this patient population, OCTN1 and IGR variations within the IBD5 haplotype were not significant predictors of PCD. Conclusion: Colon/ileocolic CD location appears to be a significant predictor of perianal manifestations of CD. Patients with PCD are more likely to require permanent fecal diversion. We did not identify any genetic variations or combination of clinical findings and genetic variations within the CARD15/NOD2, IL-23r, and OCTN1 genes or IGR that were predictive of PCD.

Aim We herein describe the different aspects of surgical behaviour. How surgeons behave affects every aspect of a surgeon's life: in the operating room, at the patient bedside, in the classroom, in the laboratory and even in public as a role model and leader. Methods In the present review, the notion of patient safety has become intertwined with the concept of surgical behaviour. Any type of behaviour by a surgeon that interferes with patient care or the ability of others to provide patient care is deleterious and might have an adverse effect on patient safety. Results Disruptive behaviour has been defined as ‘personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care’. Bad behaviour does not change; what begins incorrectly, frequently only becomes worse with time. It is a disservice to students and trainees not to give them feedback; that is, correct such behaviour. Although recent changes in training appear to lessen the apprentice nature within surgery, it is still a profession whereby trainees largely learn by example. Conclusion We must always remember that we are being observed by others. Surgeons must never fail to provide the most positive role model.

AWCR offers acceptable results in very high-risk patients with tolerable postoperative infection rates.