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Aim: We studied the levels of amylase in drain fluid to investigate its utility as a biomarker of anastomotic leak in ileal pouch patients who did not have a covering loop ileostomy. The luminal contents of the small intestine are high in amylase. Ileal J pouches are formed for restoration of continuity in patients with ulcerative colitis after removal of the colon and rectum. A drain is placed alongside the ileal pouch in the pelvis. Method: This study is a retrospective analysis of prospectively collected daily drain fluid amylase levels in consecutive patients undergoing restorative proctectomy and ileal J pouch anal anastomosis, without a covering loop ileostomy, between November 2016 and April 2018. Results: Thirteen patients underwent surgery without a covering loop ileostomy. Two patients suffered an anastomotic leak and were returned to theatre, one on day 5 and the other on day 6 postoperatively. The mean daily drain fluid amylase level in those who did not leak was between 25 and 46 U/l with a range of 22–139 U/l for all samples collected. In the two patients who suffered a clinical leak the drain fluid amylase level rose to 22 432 and 10 212 U/l on the day of clinical leak diagnosis. The mean rectal tube (intraluminal) amylase level was 63 097 U/l as measured on day 1 postoperatively. Conclusion: In this small cohort of patients, the measurement of drain fluid amylase is a highly sensitive biomarker of clinical anastomotic leak. [ABSTRACT FROM AUTHOR]

The article presents case studies related to rectal diseases in which to indocyanine green fluorescence angiography (ICGFA) performed during laparoscopic and robotic colorectal surgery. Topics discussed include complications of colorectal surgery, role of dissection in the colorectal malignancies, and the usage of robotic colorectal surgery.

Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery. The physiological activity of pancreatic enzymes in the ileum has been studied in healthy volunteers but not quantitated with the simple and readily available amylase measurements employed with serum tests. We aim to quantitate the levels of amylase in the terminal ileum. This was a prospective, non-randomised, non-blinded, consecutive cohort study conducted at the Royal Brisbane and Women's Hospital. Consecutive patients undergoing routine surgery with an ileostomy were invited to participate in the study. Ileostomy effluent was collected and analysed daily for the first 5 post-operative days. This validation cohort included 8 males and 3 females, with a mean age of 49 years. Median daily amylase levels ranged from 4470 U/L to 23,000 U/L, with no specimens falling within the laboratory serum reference range of 40 to 130 U/L. Two specimens were not available on day one post-operative due to complete ileus. The sample size of 11 patients is small but was considered sufficient given that 55 effluent specimens were anticipated for analysis. Amylase levels remain highly elevated as the enzyme transits through the length of the small intestine and measured in the terminal ileum, and can be readily quantitated by the existing testing methodology routinely available. [ABSTRACT FROM AUTHOR]

The article focuses on minimally invasive approach to the removal of a retrorectal tumour and lesions requires extensive knowledge of pelvic anatomy and expertise in pelvic surgery. It mentions retrorectal tumours are frequently asymptomatic and typically excised using a posterior approach that involves disarticulation and resection of the coccyx. It also mentions demonstrate the successful excision of a retrorectal ganglioneuroma via a laparoscopic approach.

The article presents a case study of a 72-year-old man underwent a robotic high anterior resection for a colovesical fistula secondary to diverticular disease. His computed tomography (CT) features of a phlegmon with associated obstructive uropathy. It mentions ureteric catheters were placed via cystoscopy after induction of general anaesthesia and commencing the colorectal procedure and prevent iatrogenic ureteric injury during robotic colorectal surgery.