Background: Acute colonic bleeding is a serious medical emergency. Computed tomography mesenteric angiography (CTMA) has become a critical diagnostic tool, enabling rapid identification of active haemorrhage. In many tertiary centres, interventional radiology guided angiography with embolisation has emerged as an effective and minimally invasive first line method for achieving haemostasis. While effective, the procedure carries a risk of colonic ischaemia. This study evaluates the impact of timing from CTMA to angiography on embolisation success, and identifies clinical and biochemical predictors of post-embolisation colonic ischaemia. Methods: A retrospective cohort study was conducted at Liverpool Hospital (2015–2017) involving 58 patients with acute colonic bleeding and positive CTMA. Patient demographics, medication history, procedural details, and post-procedure outcomes were analysed. Inflammatory markers (CRP, WCC) were monitored over three days post-embolisation. Statistical analyses included univariate and multivariate testing with significance at p < 0.05. Results: Of 58 patients, 38 underwent embolisation. Successful embolisations occurred significantly earlier post-CTMA (mean 80 minutes sooner) than unsuccessful cases. Colonic ischaemia occurred in 10% of patients post-embolisation, with most cases involving superior mesenteric artery branches. Anticoagulant use was significantly associated with ischaemia (p = 0.05). Patients who developed ischaemia had a steeper rise in CRP compared to non-ischaemic cases (D2 CRP: 139 vs 53 mg/L). Three patients required surgical resection due to ischaemic complications. Conclusion: Prompt angiography following CTMA improves embolisation success. Anticoagulation and rising CRP are potential predictors of post-embolisation ischaemia. These findings support early intervention, selective embolisation strategies, and vigilant post-procedure monitoring, particularly in anticoagulated patients.

Introduction Research demonstrates that sexual dysfunction is a major concern for early-onset colorectal cancer (EOCRC) survivors and a key contributor to impaired quality of life. Despite this, sexual function outcomes after EOCRC remain poorly characterised. Aims This study aimed to assess sexual function in EOCRC survivors and to identify demographic, psychological, and treatment-related factors associated with sexual dysfunction. Methods A retrospective case–control cohort study was conducted involving EOCRC survivors diagnosed before age 50 and living in Canterbury, New Zealand, compared with age-matched controls. Sexual function was assessed using validated instruments: the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Depression and anxiety were measured using the PHQ-9 and GAD-7 questionnaires. Logistic and linear regression analyses were used to compare rates and severity of sexual dysfunction and to explore associated factors. Results A total of 104 EOCRC survivors (56 women, 48 men) and 94 controls were included. Female EOCRC survivors had significantly higher rates of sexual dysfunction than controls (68% vs 35%, p=0.001), with significantly lower scores across five of six sexual function domains. Male survivors did not have significantly higher overall rates of erectile dysfunction compared with controls, but demonstrated significantly poorer sexual desire and orgasmic function (p<0.05). Male EOCRC survivors had significantly higher rates of depression (47.9% vs 27.4%) and anxiety (56.2% vs 25.4%) compared with controls (p<0.05). Depression, radiation, chemotherapy and advanced disease stage were significantly associated with worse sexual function. Conclusions EOCRC treatment is associated with significant impairments in sexual function, with a greater burden observed among women. In contrast, depressive symptoms were more pronounced among men, and depression, alongside cancer treatment–related factors, was a key determinant of sexual dysfunction across both sexes.

Abstract Postoperative recurrence at the anastomotic site remains a major challenge following ileocolic resection for Crohn’s disease. The Kono-S anastomosis, an antimesenteric, hand-sewn functional end-to-end anastomosis designed to minimise mesenteric involvement, has been proposed to reduce anastomotic recurrence. This study aimed to evaluate the clinical and endoscopic outcomes of the Kono-S anastomosis compared with conventional stapled side-to-side anastomosis in patients undergoing ileocolic resection for Crohn’s disease. Methodology Study Design and Setting A retrospective comparative cohort study was conducted at a tertiary colorectal referral centre. Consecutive patients undergoing ileocolic resection for Crohn’s disease between January 2016 and December 2024 were included. Participants Inclusion criteria were adults (≥18 years) undergoing primary or repeat ileocolic resection with primary anastomosis. Exclusion criteria included emergency surgery, diverting stoma formation, multivisceral resections, and less than 12 months of postoperative follow-up. Patients were stratified into two groups based on anastomotic technique: •Kono-S anastomosis group •Conventional stapled side-to-side anastomosis group Results A total of 186 patients were included (Kono-S n = 74; conventional anastomosis n = 112). Baseline demographics, disease phenotype, and use of biologic therapy were comparable between groups. Primary Outcome •Endoscopic recurrence at 12 months was significantly lower in the Kono-S group (18.9%) compared with the conventional group (42.0%, p < 0.001). Conclusion The Kono-S anastomosis is associated with significantly lower endoscopic and clinical recurrence rates following ileocolic resection for Crohn’s disease without increasing postoperative morbidity or anastomotic complications. These findings support the Kono-S technique as a durable and safe anastomotic strategy in Crohn’s disease surgery. Prospective randomised trials with longer follow-up are warranted to further define its role as the preferred standard of care.

Purpose: In 2025 University Hospital Geelong officially introduced a formalised robotic colorectal surgery program, expanding on its longstanding colorectal and robotic service. This paper explores the impact of the regional program on the surgical education for fellows and trainees. The aim is to examine how the transition to this new modality affects trainee surgeons' access to primary operating opportunities for colorectal resections as senior surgeons adapt to the new technology. Methodology: The study utilized a comparative data analysis of primary operating surgeons' roles before and after the formal introduction of the robotic service. Data were examined to compare the involvement of trainees and fellows in assisting and subsequent primary operating within the department against the data of consultant surgeons for the 2024 and 2025 periods. Results: The transition created a short-term "learning phase" that had significant implications for trainee surgeons, particularly regarding their access to primary operating opportunities as senior surgeons adapted. Despite this, the move reflects a critical shift, with early adoption and skills acquisition in robotics viewed as essential advantages for the next generation of surgeons. Conclusion: The introduction of robotic surgery changes the dynamics of surgical education, presenting short-term challenges for trainee operating access while simultaneously offering long-term benefits in essential skills acquisition. This study highlights the evolving landscape of training in the robotic era in the regional health care setting.

Purpose Aortic calcification assessed on staging CT may aid as a prognostic biomarker for postoperative outcomes in rectal cancer, potentially reflecting vascular health impacts on complications and survival in this cohort. This study investigates its associations with post-operative complications, outcomes and overall survival (OS) in a rectal cancer cohort. Methodology Analysis of 100 rectal cancer patients was taken from the ACCORD (Australian Comprehensive Cancer Outcomes and Research Database) database from 2013-2022. Aortic calcification measurements calculated using 3D SlicerTM version 5.10 with aortic calcification quantified as total calcium score (L1 to iliacs). Complications were evaluated binarily in surgical cases (n=71) using the Clavien Dindo Classification. OS was assessed from diagnosis to death or last follow-up (n=99, median 973 days). Analyses included t-tests, logistic regression for complications, and Cox regression for OS, adjusted for age and gender. Results Analysis of 100 rectal cancer patients was conducted. The mean was age 67.9 years (Range 28.7 to 95). 71 patients underwent operative management with 29 receiving palliative treatment. 14% (10/71) of cases had a Clavien Dindo complication 3 or above, with no significant correlation with increased calcification (mean score: 3632 vs. 2947 in complication vs. no-complication groups; p=0.664). Higher calcification independently predicted early cancer related mortality (HR=1.052 per 1000-unit increase, 95% CI: 1.010–1.096, p=0.014). Conclusion Aortic calcification emerges as a prognostic imaging biomarker for worse postoperative survival in rectal cancer, independent of complications. Further data from this data set will need to be added to support its integration into risk stratification models.

Purpose Low Anterior Resection Syndrome (LARS) is common after sphincter-preserving surgery for rectal cancer and often compounded by neoadjuvant chemoradiotherapy. Conservative management of refractory symptoms often results in unsatisfactory quality of life (QoL). Sacral Nerve Stimulator (SNS) has been proposed as a therapeutic option for refractory symptoms. This study aims to evaluate the effect of SNS on incontinence and QoL in patients with LARS following rectal cancer treatment. Methodology We performed a single centre, retrospective cohort study examining the change in LARS symptoms following SNS implantation. All patients had previously undergone sphincter-preserving surgery for rectal cancer and exhibited persistent LARS symptoms despite multidisciplinary conservative management. Between January 2023 and July 2024, ten consecutive patients who underwent SNS insertion were identified. Demographic, peri-operative and adjuvant treatment data were collected retrospectively from medical records. Primary outcomes included changes in bowel function using LARS score and Wexner faecal incontinence score. QoL was assessed using the EQ-5D-5L questionnaire. Pre- and post-operative patient reported outcome measures were compared, with post-operative assessment done at least three months following implantation. Results Ten patients underwent SNS implantation. Patients were split evenly by sex with median age of 53 years. All patients had undergone ultra-low anterior resection with diverting ileostomy and neoadjuvant chemoradiotherapy. Prior to SNS, 90% of patients had major LARS. Following SNS implantation, 80% of patients had improved LARS score (37.4 vs 29.6, p<0.05), whilst no patients had worse LARS symptoms. Conclusion We present early retrospective cohort data demonstrating significant improvement in QoL in LARS patients who have undergone SNS implantation. This demonstrates SNS can effectively reduce faecal incontinence and improve the QoL of rectal cancer patients.

Introduction: Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is important to enable early intervention. Temporary diverting ileostomy (TDI) does not prevent AL and presents inherent complications. Numerous drain fluid biomarkers have been studied in colorectal surgery and extravasated intraluminal substances such as lipase have shown promise. The aim of this study was to assess drain fluid lipase (DFL) as a biomarker of AL after rectal resection with low colorectal anastomosis and no TDI. Methods: This prospective observational cohort study collected samples of DFL in consecutive patients undergoing rectal resection with low colorectal anastomosis and without TDI. Data were collected and analysed relating to patient demographics, operation, indication and daily DFL measurements from pelvic drains. Results: Between August 2018 and March 2021, there were 62 patients recruited who met eligibility criteria. Overall, the anastomotic leak rate was 9.7% (6/62). These six patients were assigned to the AL group. The DFL on postoperative day 3 was found to be higher in the AL group compared to the NAL group (p = 0.034). A DFL cutoff threshold of less than 64 U/L was found to have a negative predictive value of 97.6% and negative likelihood ratio of 0.32 in excluding AL. Conclusion: This is the first study is to assess the utility of DFL as a biomarker for AL following colorectal anastomosis without TDI. The measurement of DFL has value as a strong negative predictor of AL and moderate impact on post-test probability. The results are comparable to the use of systemic biomarkers.