Background Acute appendicitis is the most common non‐obstetric surgical presentation during pregnancy. There were concerns that laparoscopic appendicectomy increases the risk of foetal loss compared to an open approach. Therefore, with recent advances in perioperative care, it is likely the risk has changed. Here, we performed an updated meta‐analysis assessing the safety of laparoscopic appendicectomy in pregnant women. Methods A meta‐analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was undertaken between 2000 and 2017 on Ovid Medline and Embase. The primary outcome measures were foetal loss and preterm delivery, whereas secondary outcome measures were operative time and hospital length of stay. A random‐effect model was performed to pool odds ratio (OR) and standardized mean difference (SMD). Results Seventeen observational studies were included, with 1886 patients in the laparoscopic and 4261 patients in the open group. Comparing laparoscopic versus open appendicectomy, there were 54 (5.96%) and 136 (3.73%) foetal losses, respectively. However, preterm delivery was much higher in the open approach (8.99%) compared to laparoscopic approach (2.84%). Pooled OR for foetal loss was 1.84 (95% confidence interval (CI) 1.31–2.58, P < 0.001), whereas OR for preterm delivery was 0.39 (95% CI 0.27–0.55, P < 0.001). There was no significant difference between both approaches for operative time (SMD −0.07; 95% CI −0.43 to 0.30, P = 0.71) or hospital length of stay (SMD −0.34; 95% CI −0.83 to 0.16, P = 0.18). Conclusion In a pooled analysis of level III evidence, laparoscopic appendicectomy posed a higher risk of foetal loss but lower risk of preterm delivery. Caution and informed consent are crucial when offering a laparoscopic approach.

Appendicorectal fistula can be a cause of chronic abdominal pain, forming years after an occult episode of appendicitis. It can be diagnosed with Colonoscopy and Magnetic Resonance Imaging, and successfully treated surgically with laparoscopic appendicectomy and stapled segmental cuff resection of the rectum.

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Background: The incidence of colorectal cancer (CRC) in younger adults (<50 years old) is rising worldwide, at a rate of 1% per annum since mid-1980s. The clinical concern is that younger adults may have more advanced disease leading to poorer prognosis compared to their older cohort due to lack of screening. Therefore, the aim of this study is to assess the incidence and short-term outcomes of colorectal cancer in younger adults. Methods: This is a retrospective study from a prospectively maintained bi-national database from 2007 to 2018. Results: There were 1540 younger adults diagnosed with CRC, with a rise from 5.8% in 2007 to 8.4% in 2018. Majority had lower American Society of Anaesthesiologists (ASA) scores (89%), rectal cancers (46.1%) and higher tumour stage (65.4%). As a consequence, they were likely to have higher circumferential resection margin positivity (6%, P = 0.02) and to receive adjuvant chemotherapy (57.1%, P < 0.001) compared to their older cohort. Multivariate analysis showed disadvantaged socioeconomic status (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.37-7.94, P < 0.001) and increasing tumour stage (OR 14.9, 95% CI 1.89-116.9, P < 0.001) were independent predictors for circumferential resection margin positivity whereas being female (OR 0.71, 95% CI 0.53-0.95, P = 0.02), higher ASA score (OR 175.3, 95% CI 26.7-1035.5, P < 0.001), urgent surgery (OR 2.75, 95% CI 1.84-4.11, P < 0.001) and anastomotic leak (OR 5.02, 95% CI 3.32-7.58, P < 0.001) were predictors of inpatient mortality. Conclusion: There is a steady rise in the incidence of colorectal cancer in younger adults. Both physicians and younger adults should be aware of the potential risk of colorectal cancer (CRC) and appropriate investigations performed so not to delay the diagnosis.

Purpose  To determine if patients presenting for colonoscopy can remember information discussed in the informed consent process. Focusing on whether patients know of the possible risks. Methodology  A prospective study of patients presenting for elective colonoscopy through the Colorectal Unit. Patients were consented in outpatient clinics prior to the procedure using the colonoscopy consent form supplied by Queensland Health. On the day of the procedure a 2 page questionnaire with 13 questions was completed by the patient prior to their colonoscopy. Indications for colonoscopy date of consent & procedure and seniority of consenting doctor were obtained from medical records. Results  100 patients completed the questionnaire. 94% of patients could correctly identify colonoscopy as the procedure being undertaken. 45% of patients were able to identify that there were any risks involved with the procedure. Only 28% of patients could name perforation as a possible risk. h regard to other investigative options 83% could not identify any from a list of three. Despite this 92% felt they were given enough information and were happy to proceed. Conclusion  This study highlights room for improvement in the current informed consent process. The current process falls short in educating patients of the possible serious risks involved. Patients do not recall other therapeutic options given. The consent process does convey basic information allowing the patient to identify the name of the investigation and anatomical area investigated. Despite these shortcomings most patients felt they were given enough information to proceed.