Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.005
Peter J. Bazira
The rectum and anal canal are the terminal portions of large intestine and the entire gastrointestinal tract. They are thus readily accessible to direct inspection and examination. The rectum functions as a distensible reservoir for faeces, while the anal canal possesses a powerful muscular sphincter in its wall which is important in maintaining faecal continence. Diseases of the rectum and anal canal, both benign and malignant, account for a very large part of colorectal surgical practice worldwide. This article emphasizes the clinically and surgically relevant aspects of the anatomy of the rectum and anal canal.
{"title":"Anatomy of the rectum and anal canal","authors":"Peter J. Bazira","doi":"10.1016/j.mpsur.2025.11.005","DOIUrl":"10.1016/j.mpsur.2025.11.005","url":null,"abstract":"<div><div>The rectum and anal canal are the terminal portions of large intestine and the entire gastrointestinal tract. They are thus readily accessible to direct inspection and examination. The rectum functions as a distensible reservoir for faeces, while the anal canal possesses a powerful muscular sphincter in its wall which is important in maintaining faecal continence. Diseases of the rectum and anal canal, both benign and malignant, account for a very large part of colorectal surgical practice worldwide. This article emphasizes the clinically and surgically relevant aspects of the anatomy of the rectum and anal canal.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 8-15"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.002
Megan J. Reiniers, Alan F. Horgan
Enhanced recovery after surgery (ERAS) programmes utilize a multi-modal and multidisciplinary approach to surgical care. The aim of ERAS is to reduce the surgical stress response, to maintain physiological function and metabolic homeostasis and to expedite patients’ recovery to their baseline status. Following its success in colorectal surgery, ERAS is increasingly adopted by other surgical specialities. A good ERAS programme involves integrated preoperative, intra-operative and postoperative evidence-based practice. Successful ERAS programmes translate to a standardized patient care pathway, improved clinical outcomes and shorter hospital stay, all of which will help facilitate the increasing demand on healthcare and bed pressure. Its principles and many components are not only transferable to other surgical specialities, but may also allow medical specialities to improve patient care and recovery. ERAS is therefore expected to become the standard of care for the majority of hospital inpatients.
{"title":"Enhanced recovery in intestinal surgery","authors":"Megan J. Reiniers, Alan F. Horgan","doi":"10.1016/j.mpsur.2025.11.002","DOIUrl":"10.1016/j.mpsur.2025.11.002","url":null,"abstract":"<div><div>Enhanced recovery after surgery (ERAS) programmes utilize a multi-modal and multidisciplinary approach to surgical care. The aim of ERAS is to reduce the surgical stress response, to maintain physiological function and metabolic homeostasis and to expedite patients’ recovery to their baseline status. Following its success in colorectal surgery, ERAS is increasingly adopted by other surgical specialities. A good ERAS programme involves integrated preoperative, intra-operative and postoperative evidence-based practice. Successful ERAS programmes translate to a standardized patient care pathway, improved clinical outcomes and shorter hospital stay, all of which will help facilitate the increasing demand on healthcare and bed pressure. Its principles and many components are not only transferable to other surgical specialities, but may also allow medical specialities to improve patient care and recovery. ERAS is therefore expected to become the standard of care for the majority of hospital inpatients.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 32-36"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.12.002
Shu Ning Yew, Bo Yuan Khor, Daniel Hanratty
Surgery remains the mainstay of treatment for colorectal cancer for curative outcomes. This article outlines the preoperative, perioperative, intraoperative and postoperative management of patients who undergo colorectal surgery. The first section discusses preoperative planning, including the role of the multidisciplinary team (MDT) in decision-making and preoperative patient optimization. The second section discusses the principles of oncological resection and outlines surgical techniques for common colorectal cancer procedures, aiming to achieve R0 resection and minimize complications. The final section touches on relevant topics such as postoperative follow-up and surveillance, cytoreductive surgery, pelvic exenteration, and the management of colorectal liver metastases.
{"title":"Surgery for colorectal cancer","authors":"Shu Ning Yew, Bo Yuan Khor, Daniel Hanratty","doi":"10.1016/j.mpsur.2025.12.002","DOIUrl":"10.1016/j.mpsur.2025.12.002","url":null,"abstract":"<div><div>Surgery remains the mainstay of treatment for colorectal cancer for curative outcomes. This article outlines the preoperative, perioperative, intraoperative and postoperative management of patients who undergo colorectal surgery. The first section discusses preoperative planning, including the role of the multidisciplinary team (MDT) in decision-making and preoperative patient optimization. The second section discusses the principles of oncological resection and outlines surgical techniques for common colorectal cancer procedures, aiming to achieve R0 resection and minimize complications. The final section touches on relevant topics such as postoperative follow-up and surveillance, cytoreductive surgery, pelvic exenteration, and the management of colorectal liver metastases.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 37-43"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.007
Mohamad FA Kamarizan, Adel MM Mahmoud, Rami W Radwan
Despite laparoscopic surgery being widely performed in gastrointestinal surgery, there are inherent technical constraints that limit its use, especially in confined and complex procedures. The advent of robotic surgery has revolutionized surgical practice, with an increasing number of platforms becoming available on the market. The use of articulating robotic arms and instruments, enhanced three-dimensional displays, and improved ergonomics have significantly transformed the way gastrointestinal surgery is performed. Proponents of robotic-assisted surgery (RAS) highlight different technical, patient outcomes and ergonomic advantages. Still, sceptics argue that the cost of operating the robotic platforms outweighs the modest benefit they bring. The article aims to explore the various robotic platforms used in gastrointestinal surgery, the benefits of robotic-assisted surgery, the associated economics of its use, and the training model employed to achieve mastery on the platform, based on recently published evidence. With increasing experience, wider adoption of the system, greater competition among different robotic platforms, and improved training, robotic-assisted surgery is expected to become the standard of care in gastrointestinal surgery.
{"title":"Updates in robotic colorectal surgery","authors":"Mohamad FA Kamarizan, Adel MM Mahmoud, Rami W Radwan","doi":"10.1016/j.mpsur.2025.11.007","DOIUrl":"10.1016/j.mpsur.2025.11.007","url":null,"abstract":"<div><div>Despite laparoscopic surgery being widely performed in gastrointestinal surgery, there are inherent technical constraints that limit its use, especially in confined and complex procedures. The advent of robotic surgery has revolutionized surgical practice, with an increasing number of platforms becoming available on the market. The use of articulating robotic arms and instruments, enhanced three-dimensional displays, and improved ergonomics have significantly transformed the way gastrointestinal surgery is performed. Proponents of robotic-assisted surgery (RAS) highlight different technical, patient outcomes and ergonomic advantages. Still, sceptics argue that the cost of operating the robotic platforms outweighs the modest benefit they bring. The article aims to explore the various robotic platforms used in gastrointestinal surgery, the benefits of robotic-assisted surgery, the associated economics of its use, and the training model employed to achieve mastery on the platform, based on recently published evidence. With increasing experience, wider adoption of the system, greater competition among different robotic platforms, and improved training, robotic-assisted surgery is expected to become the standard of care in gastrointestinal surgery.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 44-50"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.12.001
Adrian Ben Cresswell
{"title":"Test yourself: MCQ and Single Best Answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.12.001","DOIUrl":"10.1016/j.mpsur.2025.12.001","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 65-66"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.004
Peter J Bazira
The large intestine comprises the caecum and appendix, colon, rectum, and anal canal from proximal to distal. Embryologically, the proximal half of the large intestine is derived from the midgut, while the distal half develops from the hindgut. This dual derivation is reflected in the difference in arterial supply to its proximal (superior mesenteric artery) and distal (inferior mesenteric artery) portions. Physiologically, the large intestine primarily functions to absorb water and essential electrolytes (sodium and chloride) from its luminal contents leaving the unabsorbed residue to be excreted as faeces. Fibreoptic colonoscopy and MRI and CT colonography allow detailed internal inspection of the large intestine with relative ease and with minimal discomfort. This article highlights the clinically and surgically relevant aspects of the anatomy of the caecum, appendix, and colon.
{"title":"Anatomy of the caecum, appendix, and colon","authors":"Peter J Bazira","doi":"10.1016/j.mpsur.2025.11.004","DOIUrl":"10.1016/j.mpsur.2025.11.004","url":null,"abstract":"<div><div>The large intestine comprises the caecum and appendix, colon, rectum, and anal canal from proximal to distal. Embryologically, the proximal half of the large intestine is derived from the midgut, while the distal half develops from the hindgut. This dual derivation is reflected in the difference in arterial supply to its proximal (superior mesenteric artery) and distal (inferior mesenteric artery) portions. Physiologically, the large intestine primarily functions to absorb water and essential electrolytes (sodium and chloride) from its luminal contents leaving the unabsorbed residue to be excreted as faeces. Fibreoptic colonoscopy and MRI and CT colonography allow detailed internal inspection of the large intestine with relative ease and with minimal discomfort. This article highlights the clinically and surgically relevant aspects of the anatomy of the caecum, appendix, and colon.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 1-7"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.003
Adrian C Bateman
Colorectal cancer (CRC) is one of the most common cancers worldwide. However, early detection and treatment can lead to very good clinical outcomes. This article highlights the pathology-related aspects of CRC that are most relevant to colorectal surgeons. This includes sections on epidemiology, aetiology, presentation, macroscopic and microscopic features, pathological staging, prognosis, precursor lesions and molecular pathways, follow-up and bowel cancer screening. The main section on CRC is preceded by a description of the types of colorectal polyp that are most commonly encountered in clinical practice, many of which are associated with the development of CRC.
{"title":"Pathology of colorectal polyps and cancer","authors":"Adrian C Bateman","doi":"10.1016/j.mpsur.2025.11.003","DOIUrl":"10.1016/j.mpsur.2025.11.003","url":null,"abstract":"<div><div>Colorectal cancer (CRC) is one of the most common cancers worldwide. However, early detection and treatment can lead to very good clinical outcomes. This article highlights the pathology-related aspects of CRC that are most relevant to colorectal surgeons. This includes sections on epidemiology, aetiology, presentation, macroscopic and microscopic features, pathological staging, prognosis, precursor lesions and molecular pathways, follow-up and bowel cancer screening. The main section on CRC is preceded by a description of the types of colorectal polyp that are most commonly encountered in clinical practice, many of which are associated with the development of CRC.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 16-23"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.006
Rachel SM Heard, Martyn D Evans
Intestinal obstruction is a common condition with substantial morbidity and mortality. It is commonly divided into small and large bowel subtypes. Common causes of small bowel obstruction (SBO) are adhesions and hernias; of large bowel obstruction (LBO) are cancer and diverticular disease. Prompt surgical referral is advised for both subtypes. There are several conditions which may mimic obstruction, including pseudo-obstruction and ileus. The initial management is the same for both SBO and LBO, i.e. resuscitation, symptom relief and assessment for diagnosis and complications. Because of the need for prompt surgical intervention in the presence of complications, resuscitation and investigation should occur simultaneously. The radiological investigation of choice is a CT scan, as this can assess for aetiology and complications such as ischaemia or perforation, as well as confirming a diagnosis of bowel obstruction. In uncomplicated adhesional SBO, it is often appropriate to instigate a conservative approach for the first 24–48 hours, with a nasogastric tube and IV fluid resuscitation, with or without a Gastrografin challenge. For all other aetiologies of bowel obstruction, surgery will probably be required to resolve the obstruction. A key factor in reducing mortality is the early recognition and management of complications of bowel obstruction.
{"title":"Intestinal obstruction, an overview","authors":"Rachel SM Heard, Martyn D Evans","doi":"10.1016/j.mpsur.2025.11.006","DOIUrl":"10.1016/j.mpsur.2025.11.006","url":null,"abstract":"<div><div>Intestinal obstruction is a common condition with substantial morbidity and mortality. It is commonly divided into small and large bowel subtypes. Common causes of small bowel obstruction (SBO) are adhesions and hernias; of large bowel obstruction (LBO) are cancer and diverticular disease. Prompt surgical referral is advised for both subtypes. There are several conditions which may mimic obstruction, including pseudo-obstruction and ileus. The initial management is the same for both SBO and LBO, i.e. resuscitation, symptom relief and assessment for diagnosis and complications. Because of the need for prompt surgical intervention in the presence of complications, resuscitation and investigation should occur simultaneously. The radiological investigation of choice is a CT scan, as this can assess for aetiology and complications such as ischaemia or perforation, as well as confirming a diagnosis of bowel obstruction. In uncomplicated adhesional SBO, it is often appropriate to instigate a conservative approach for the first 24–48 hours, with a nasogastric tube and IV fluid resuscitation, with or without a Gastrografin challenge. For all other aetiologies of bowel obstruction, surgery will probably be required to resolve the obstruction. A key factor in reducing mortality is the early recognition and management of complications of bowel obstruction.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 51-58"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.mpsur.2025.11.008
Drew Magowan, Dean Harris
Colorectal cancer (CRC) is the third most common cancer for both men and women in the UK, with over 44,000 new cases and 16,000 deaths each year. CRC arises from polyps as part of the adenoma–carcinoma sequence. The UK bowel cancer screening programme (BCSP) uses a faecal immunochemical test (FIT) and direct visualization by colonoscopy, and has been shown to increase early CRC detection rates and improve survival outcomes. We review the current evidence and summarise CRC, BCSP and potential future developments in screening.
{"title":"Bowel cancer screening","authors":"Drew Magowan, Dean Harris","doi":"10.1016/j.mpsur.2025.11.008","DOIUrl":"10.1016/j.mpsur.2025.11.008","url":null,"abstract":"<div><div>Colorectal cancer (CRC) is the third most common cancer for both men and women in the UK, with over 44,000 new cases and 16,000 deaths each year. CRC arises from polyps as part of the adenoma–carcinoma sequence. The UK bowel cancer screening programme (BCSP) uses a faecal immunochemical test (FIT) and direct visualization by colonoscopy, and has been shown to increase early CRC detection rates and improve survival outcomes. We review the current evidence and summarise CRC, BCSP and potential future developments in screening.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 24-31"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An intestinal stoma is an opening created surgically connecting the bowel to the skin for predominantly diversion of faeces it remains essential in gastrointestinal surgery. The main types of intestinal stoma are ileostomy and colostomy, they are classified by anatomical site, configuration, duration and function. Indications for stoma include decompression of bowel, faecal diversion or enteral feeding in conditions such as inflammatory bowel disease, malignancy or trauma. Techniques for stoma formation include open, trephine, laparoscopic or robotic. Each technique includes careful and adequate mobilization of bowel, preserving good quality blood supply and constructing a tension free stoma. Complications occur in around 40% of cases, early complications include ischaemia or retraction, and late complications include parastomal hernia and stenosis. Effective stoma care involves education and psychological support from specialist stoma nurses and has been demonstrated to significantly improve quality of life in this patient cohort. Minimally invasive robotic techniques are emerging along with other technological innovations such as three-dimensional (3D)-printed appliances and artificial intelligence (AI)-supported online care. These are improving both recovery in the postoperative phase and comfort in the longer term.
{"title":"Intestinal stomas","authors":"Dominic Thompson, Glynnis Morris, Rhiannon Harries","doi":"10.1016/j.mpsur.2025.11.009","DOIUrl":"10.1016/j.mpsur.2025.11.009","url":null,"abstract":"<div><div>An intestinal stoma is an opening created surgically connecting the bowel to the skin for predominantly diversion of faeces it remains essential in gastrointestinal surgery. The main types of intestinal stoma are ileostomy and colostomy, they are classified by anatomical site, configuration, duration and function. Indications for stoma include decompression of bowel, faecal diversion or enteral feeding in conditions such as inflammatory bowel disease, malignancy or trauma. Techniques for stoma formation include open, trephine, laparoscopic or robotic. Each technique includes careful and adequate mobilization of bowel, preserving good quality blood supply and constructing a tension free stoma. Complications occur in around 40% of cases, early complications include ischaemia or retraction, and late complications include parastomal hernia and stenosis. Effective stoma care involves education and psychological support from specialist stoma nurses and has been demonstrated to significantly improve quality of life in this patient cohort. Minimally invasive robotic techniques are emerging along with other technological innovations such as three-dimensional (3D)-printed appliances and artificial intelligence (AI)-supported online care. These are improving both recovery in the postoperative phase and comfort in the longer term.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"44 1","pages":"Pages 59-64"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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