Laparoscopic colectomy in a district hospital: the single surgeon can be safe.

BACKGROUND: Several outcome measures have been identified for colorectal surgery and published in the literature. This study sought to compare outcomes of high volume laparoscopic colectomy by a single surgeon in a district hospital with outcomes from tertiary referral centres. METHODS: This was a retrospective review of elective laparoscopic colectomy by a single laparoscopic general surgeon in a district hospital over a 51-month period using a prospectively maintained database. The key outcome measures studied were length of hospital stay, conversion to open, anastomotic leak, wound infection, re-admission and 30-day mortality. RESULTS: 187 elective laparoscopic colectomies were performed at the Kent and Canterbury Hospital between July 2008 and October 2012. The median patient age was 69 years (range 22-90 years). Median length of hospital stay was 4 days (range 1-48 days). Anastomotic leak occurred in 4 (2.1%) patients. Seven (3.7%) patients underwent conversion to open surgery. Re-admission occurred in 4 (2.1%) patients for small bowel obstruction (1), wound infection (1), anastomotic leak (1) and colo-vaginal fistula (1). There was one post-operative death from severe chest infection (0.5%). These results are similar to those published by tertiary referral centres. CONCLUSIONS: This study of outcomes at a district hospital shows that the outcome reported from laparoscopic colorectal surgery in tertiary referral centres is reproducible at the district hospital level by a single surgeon with a high operative volume.

The Impact of High Surgical Volume on Outcomes From Laparoscopic (Totally Extra Peritoneal) Inguinal Hernia Repair.

PURPOSE: Laparoscopic hernia repair is characterised by a steep learning curve for the surgeon, and proficiency and outcomes are dependent on experience. The aim of this study was to compare laparoscopic totally extra peritoneal (TEP) inguinal hernia repair outcomes conducted by a single surgeon as experience changed over time. MATERIALS AND METHODS: Clinical records of 100 consecutive patients who underwent laparoscopic TEP inguinal hernia repair (n=113 hernias) at Kent and Canterbury Hospital by a single laparoscopic surgeon over a four-year period were reviewed for postoperative outcomes. Outcomes were compared with a previous cohort of patients undergoing TEP repair in the preceding three years. RESULTS: One patient experienced chronic postoperative pain, but there were no recurrences, wound infections, haematomas, or conversions compared to three recurrences, three conversions to open operations, one haematoma, and one episode of postoperative pain in the preceding period. CONCLUSIONS: Laparoscopic TEP inguinal hernia repair can be further improved with surgical proficiency and high surgical volumes.

Local anaesthetic surgical treatment of severe objective pulsatile tinnitus: a useful technique.

Objective pulsatile tinnitus is a rare condition with an often dramatic presentation. We present the case of a 70-year-old woman who presented with over two years' history of unilateral distressing objective pulsatile tinnitus. Carotid arteriography revealed a highly tortuous internal carotid artery. Computed tomography of the ipsilateral temporal bones showed a large jugular bulb. Internal jugular vein ligation under local anaesthetic yielded immediate resolution of her symptoms.

Small bowel evisceration following removal of an abdominal drain.

Drain site small bowel evisceration represents a small but potentially serious risk following abdominal drain removal. We present the case of a patient in whom removal of an abdominal drain was complicated by small bowel evisceration requiring surgical intervention. Strategies for management, consequences and potential preventive measures are discussed.