The shortcomings of the TWW system in its original form have now been demonstrated beyond doubt. What is needed is a fresh approach to find a cost effective and viable alternative in a climate of increased expectations and finite resources.

The PCQ-based WNS system improves specificity for detecting colorectal cancer, particularly when the WNS exceeds 70.

Anaemia is a poor predictor of right-sided colon cancers and cannot be used as an effective investigative tool in symptomatic patients.

We have shown excellent rates of healing of chronic anal fissures treated with a V-Y advancement flap regardless of sphincter pressures, previous treatment and symptom chronicity. These results show the technique can be applied to all chronic fissures with success and used as a primary therapy.

SUMMARYA 35-year-old man presented with a relatively short history of right iliac fossa pain. With an unremarkable medical history, marginally raised inflammatory markers and examination findings suggestive of acute appendicitis, a preliminary diagnosis was made and the patient listed for laparoscopic appendicectomy. However, intraoperatively, the appendix was deemed normal and, following further exploration, appendicectomy and amputation of an obviously inflamed caecal pole were carried out using a TLC 75 linear stapler. Histological analysis also confirmed a diagnosis of caecal diverticulitis. Having undergone minimally invasive surgery without unnecessary radical resection, the patient made a full recovery. BACKGROUND