Complex anal fistulae may be managed successfully by a specialized surgical approach consisting of preliminary seton drainage and staged delayed mucosal advancement anoplasty.

The clinical utilization of endorectal ultrasound has shown high accuracy for the preoperative definition of tumour and nodal stage in low rectal cancer. In Barbados, preliminary experience supports this view and has been used to select those patients best treated with preoperative radiotherapy and down staging chemoradiation.