Purpose: Laparoscopic surgery is accepted as a standard alternative to open procedures in the management of both benign and malignant colorectal disease. However, the safety and efficacy of the laparoscopic approach for emergency colorectal surgery has not been established. Hand-assisted laparoscopic (HAL) surgery might be a suitable option for colectomy in an emergency setting. The aim of this study was to report our experience of emergency HAL colectomy. Methods:This was a retrospective review of consecutive colorectal emergency cases that were treated using HAL colectomy. Patient demographics, indications for surgery, operative details, and postoperative complications were examined.Results: From March 2015 to April 2016, 18 patients underwent emergency HAL colectomy for complicated colorectal disease. Eight patients (44%) had an obstruction that required intraoperative decompression procedure. Sixteen patients (89%) had a perforation (five of which were sealed perforations involving large abscesses and inflammatory changes). Eight patients underwent sigmoidectomy, four underwent anterior resection, one underwent low anterior resection, two underwent left hemicolectomy, and three underwent Hartmann's procedure. There were two instances of open conversion (11%). The median duration of surgery was 178 minutes. The median time to bowel function recovery and median postoperative stay were 3 days and 10 days, respectively. The postoperative complication rate associated with the operation was 33% (6/18). There was one postoperative mortality. Conclusion:For the experienced surgeon, HAL can be a reasonable option for emergency colorectal surgery.

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Mining and smelting activities have strongly influenced the Sudbury region (Ontario, Canada) since the late 19th century, leading to acidification and metal contamination in many local ecosystems. Regulations on restricting acidic emissions were enacted in the 1970s, after which a considerable volume of paleolimnological work was completed to study the impacts of acidification on Sudbury‐region lakes and their subsequent biological recovery. Twenty years after the last regional diatom‐based assessment, many lakes have undergone large changes in limnological variables, including increases in pH and dissolved organic carbon concentrations, as well as decreases in metal concentrations. Additionally, these lakes are under the potential impacts of newly emerging environmental stressors such as climate warming and road salt contamination. Here, we revisited a suite of Sudbury‐region lakes (n = 80) to examine the relationships between their current water chemistry and diatom assemblages preserved in surface sediments using a canonical correspondence analysis. Although the pH gradient in our study lakes is shorter (pH ~1.4) than in earlier calibration studies conducted in this region, lake water pH was still identified as the strongest environmental variable shaping diatom distributions and was used to construct a robust inference model (R2boot = 0.73; RMSEP = 0.32). By assessing ecological changes experienced by a subset of these Sudbury‐region lakes (n = 33) over the past few decades, we identified two major trends: an overall increase in diatom‐inferred pH and a rise in the relative abundance of planktonic taxa. Our study provides useful insights into the autecology of major diatom taxa in acidified waters and highlights the importance of considering other anthropogenic stressors when assessing the recovery response of acid‐impacted systems.