The endorectal advancement flap is an effective method of repair for both anorectal and rectovaginal fistulas, even though the success rate may not be as optimistic as in some other published studies. Patient selection is imperative, realizing that a higher rate of failure may be present in Crohn's disease and rectovaginal fistulas. Control of sepsis before endorectal advancement flap with drainage of a perianal abscess and/or seton placement, whenever possible, is indicated.

Multiple risk factors exist that predispose patients to ALs. These risk factors should be considered before and during the surgical care of colorectal patients.

In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy.

Objective To evaluate causes and predictors of readmission after new ileostomy creation. Summary Background New ileostomates have been reported to have higher readmission rates compared to other surgical patients, but data on predictors are limited. Methods 1114 records at two associated hospitals were reviewed to identify adults undergoing their first ileostomy. Primary outcome was readmission within 60 days of surgery. Multiple logistic regression was used to identify independent predictors; receiver-operator characteristics (AUC) were used to evaluate age-stratified models in secondary analysis. Results 407 patients underwent new ileostomy. 58% had cancer, 31% IBD; 49% underwent LAR, 27% colectomy, 14% proctocolectomy. Median length-of-stay was 8 days. 39% returned to hospital; 28% were readmitted (n=113) at median of 12 days post-discharge. The most common causes of readmission were dehydration (42%), intra-peritoneal infections (33%), and extra-peritoneal infections (29%). Dehydration was associated with later, longer, and repeated readmission. Independent significant predictors of readmission were Clavien-Dindo complication grade 3–4 (OR 6.7), Charlson comorbidity index (OR 1.4 per point), and loop stoma (OR 2.2); longer length-of-stay (OR 0.5) and age 65 or older (OR 0.4) were protective. Cohort stratification above or below age 65 revealed that older patient readmissions were more predictable (AUC 0.84) with more preventable causes; younger patient readmissions were difficult to predict or prevent (AUC 0.65). Conclusions Readmissions are most commonly caused by dehydration, and are predicted by serious complications, comorbidity burden, loop stoma, shorter length-of-stay, and age. Readmissions in older patients are easier to predict, representing an important target for improvement.

Outcomes after hand-assisted laparoscopic sigmoidectomy for diverticulitis are similar to those seen in the pure laparoscopic method, with lower conversion rates and shorter operative times. Hand-assisted laparoscopic sigmoid resection for diverticulitis is an attractive alternative to a "pure" laparoscopic method in complicated cases.