Postoperative ileus (POI) has long been a challenging clinical problem for both patients and healthcare physicians alike. Although a standardized definition does not exist, it generally includes symptoms of intolerance to diet, lack of passing stool, abdominal distension, or flatus. Not only does prolonged POI increase patient discomfort and morbidity, but it is possibly the single most important factor that results in prolongation of the length of hospital stay with a significant deleterious effect on healthcare costs in surgical patients. Determining the exact pathogenesis of POI is difficult to achieve; however, it can be conceptually divided into patient-related and operative factors, which can further be broadly classified as neurogenic, inflammatory, hormonal, and pharmacological mechanisms. Different strategies have been introduced aimed at improving the quality of perioperative care by reducing perioperative morbidity and length of stay, which include Enhanced Recovery After Surgery (ERAS) protocols, minimally invasive surgical approaches, and the use of specific pharmaceutical therapies. Recent studies have shown that the ERAS pathway and laparoscopic approach are generally effective in reducing patient morbidity with early return of gut function. Out of many studies on pharmacological agents over the recent years, alvimopan has shown the most promising results. However, due to its potential complications and cost, its clinical use is limited. Therefore, this article aimed to review the pathophysiology of POI and explore recent advances in treatment modalities and prevention of postoperative ileus.

Aim. This study aimed to assess the impact of routine histological examination of stapled colorectal anastomotic doughnuts in patients undergoing rectal cancer surgery (RCS). Justification of biopsy examination could form part of the strategies of NHS net zero practice with effort to reduce wastage and carbon footprint. Method. A data analysis of all patients undergoing RCS during 2019–2021 at our institute was performed. We also analysed the cost of preparing and reviewing histology slides. Results. 52 patients underwent anterior resection during the aforementioned period. Doughnuts were sent in 37 (71%) patients. 23 (62%) patients were male, and 14 (38%) were female. The median age at diagnosis was 68 (range 54–84) years. All resected specimens were adenocarcinomas. Of the 37 patients, 18 (49%) underwent low anterior resection and 19 (51%) underwent high anterior resection. Proximal doughnuts were sent in 26 (70%) patients, whereas distal doughnuts were sent in all cases. Mean distal microscopic resection margin from tumour was 22 mm (range 6–45 mm). Each doughnut required 3 slides, each costing £50 and requiring 82 minutes to fix and read. This incurred a cost of £13,650 and required 19,656 hours of preparation time. All of the doughnuts as well as resection margins were negative for malignancy. Conclusion. Routine histopathological examination of doughnuts is time and cost‐intensive however provides little or no clinical value (particularly analysis of the proximal doughnut). Distal doughnuts should only be sent for histological examination in exceptional circumstances.

Background and Aim: Standardisation is crucial for outcomes in minimally invasive colorectal surgery. Debate continues regarding the comparative efficacy of robotic versus laparoscopic platforms. This study evaluates perioperative outcomes for both approaches, performed by a single surgeon using an identical standardised technique to isolate the platform's effect. Methods: A retrospective cohort study of 250 patients undergoing colorectal resection (2019-2023) was conducted. Patients were divided into laparoscopic (n=121) and robotic (n=129) groups. Data included demographics, ASA grade, conversion rates, operative times, Clavien-Dindo complications, resection margin status (R0/R1), mortality, and length of stay. R software was used for analysis. Results: Demographics were matched, but fewer high-risk (ASA III) patients were in the robotic cohort (38.7% vs. 51.3%; p<0.05). The robotic approach showed a significantly lower conversion rate (0% vs. 6.6%). A non-significant trend toward higher-grade complications existed in the laparoscopic group (median grade II vs. I; p=0.12), with a significantly higher R1 resection rate (n=8 vs. n=2). Laparoscopic 30-day (2 vs. 0) and 90-day (4 vs. 0) mortality was higher. Anastomotic leak rates (1.6% each) and median hospital stay (5 days; p=0.71) were similar in both groups. Conclusion: Using a standardised technique, outcomes are comparable except for a significantly reduced conversion rate with robotics. The observed difference in R1 resection rates may be influenced by baseline differences in patient populations. For skilled surgeons, the choice of platform may be influenced more by economic factors and preference than by major differences in clinical efficacy. What does this paper add to the literature? Debate continues regarding the comparative efficacy of robotic versus laparoscopic platforms. This single-surgeon study compares outcomes in colorectal cancer using minimally invasive procedures and a standardised technique. The result of similar clinical efficacy suggests that standardisation reduces outcome variability and demonstrates that cost and preference may influence platform choices more.