Background & Aims. Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients. Methods. Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream. Results. The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, p<0.001). 16 patients (42.1%) were on anti-TNF alpha therapy (Adalimumab (n = 5), Infliximab (n = 5) or Etanercept (n = 6)).31.3% of them used NSAIDs simultaneously, compared with 77.3% of the other patients (p<0.01). Their Lewis scores were lower compared to the other patients for the entire small bowel (306 ± 164 vs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively). Conclusion. Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).

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Background: In rectal cancer surgery, maintaining a balance between oncologic control and postoperative quality of life is critical. Sphincter-preserving procedures may offer better functional outcomes, but results vary depending on the technique used. Methods: This retrospective, observational, single-center study included 62 patients with adenocarcinoma of the rectum 5 cm from the anal verge, operated between August 2022 and August 2024. All received standard neoadjuvant therapy. Patients underwent one of three procedures: abdominoperineal resection, standard coloanal anastomosis, or delayed coloanal anastomosis (Turnbull-Cutait). Functional outcomes were assessed using LARS and St Marks scores at 1, 6, and 12 months postoperatively. Satisfaction was evaluated via telephone interviews. Results: Seventeen patients underwent abdominoperineal resection, 10 received standard coloanal anastomosis, and 35 underwent the delayed technique. Standard anastomosis yielded significantly better continence scores than the Turnbull-Cutait group. Patients with abdominoperineal resection had higher rates of pulmonary complications and prolonged inflammation. At one year, 80% of patients reported satisfaction with the procedure. Conclusion: All techniques can provide high satisfaction, but standard coloanal anastomosis appears to offer superior functional outcomes. Surgical decision-making should be individualized and based on thorough informed consent.

Background Emergency abdominal surgery is associated with high morbidity and mortality, with anastomotic leak (AL) remaining a major postoperative complication. AL occurs in approximately 10% of emergency gastrointestinal (GI) anastomoses, increasing mortality threefold and often leading to reoperation, stoma formation, and prolonged hospitalisation. SEAL-G is a novel, fully synthetic, in-situ forming alginate hydrogel designed to reinforce GI anastomoses. It adheres mechanically without heat generation, provides flexibility compatible with bowel tissue, and is absorbed over several months. Pre-clinical data show SEAL-G potentially reduces severe leaks which in a clinical environment would warrant return to theatre. However, its efficacy in true life clinical settings and emergency GI surgery remains unstudied. Aims This study aims to (1) assess clinical outcomes following SEAL-G use in emergency GI anastomoses, (2) compare outcomes with matched controls without SEAL-G, and (3) evaluate surgeons’ perspectives on SEAL-G and other anastomotic leak preventive measures and its influence on decision-making regarding anastomosis versus stoma formation. Methods A multicentre, non-interventional, observational audit will be conducted across NHS and other hospitals where SEAL-G is available. Eligible patients (>16 years) undergoing emergency GI anastomosis will be included. Patients who underwent the anastomosis with the reinforcement of SEAL-G sealant will be compared with current or historical controls. Data on demographics, peri-operative variables, and post-operative outcomes—particularly AL rates—will be collected and compared with historical or contemporaneous controls using propensity matching. Additionally, a mixed-methods qualitative evaluation (surveys, interviews, focus groups, and ethnographic observation) will explore surgeons’ experiences, perceived safety, usability, and decision-making influences. A target of 160 patients will allow robust assessment across a heterogeneous emergency surgical population.