Diverticular fistula should no longer be considered a contraindication for laparoscopic colectomy. These cases are more complex, as evidenced by the longer operating times and higher conversion rates when compared with resections for uncomplicated recurrent diverticulitis. Although the length of hospital stay was longer for patients who underwent laparoscopic colectomy for diverticular fistula, those whose operations were completed laparoscopically had the same outcome as patients with uncomplicated disease. We anticipate that minimally invasive surgery will become the standard of care for colovesical fistula, as it now is for uncomplicated diverticular disease.

This large series reaffirms the high success rate (97 percent) and relatively low acute ischemia risk (7 percent) of super-selective embolization for lower gastrointestinal bleeding. Furthermore, only 15 percent of patients ultimately required readmission for recurrent bleeding. It is our recommendation that super-selective embolization be used as the primary therapeutic modality in the treatment of angiogram positive lower gastrointestinal bleeding.

We concluded that patients referred for surgical resection of a polyp should undergo repeat colonoscopy preoperatively, given that in our study one-third of patients were spared unnecessary colectomy. In addition, repeat endoscopy by the operating surgeon offers an opportunity to confirm the location of the lesion and place a colonic tattoo to facilitate laparoscopic resection.

For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.

<p>Polyps of the colon are a common occurrence, and whose incidence increases with age.  Polyps have the ability to transform into neoplasms, and the polyp’s likelihood of becoming cancerous is closely related to its size.  The larger a polyp grows, the more likely it is to become cancerous. Once a polyp reaches 2 cm, the risk of malignant transformation is in excess of 20%. There are several subtypes of polyps: tubular, villous, or tubulovillous. Villous adenomas are the most likely to transform, whereas tubular adenomas carry the least risk.  Symptoms range from anemia and constipation, to abdominal pain and obstruction, depending on the size and location of the lesion. As a general rule, the larger the size of the polyp, the likelihood for pain and obstruction increases. Herein we present a case of a young patient presenting with mild anemia who was found to have a giant tubulovillous adenoma.</p>