Are we burying our heads in the sand? Preventing small bowel obstruction from the V-loc® suture in laparoscopic ventral rectopexy.

AIM: There have been increasing reports in the literature highlighting the complication of V-loc® associated small bowel obstruction in patients after laparoscopic ventral rectopexy. METHODS AND RESULTS: Using clinical and experimental evidence, we demonstrate that bowel obstruction from the V-loc® following laparoscopic ventral rectopexy will still occur despite the technical recommendations to bury or cut its barbed end flush. CONCLUSION: The risk of bowel obstruction from the V-loc® following laparoscopic ventral rectopexy is not negated by burying or cutting its barbed end flush. We have proposed its pathogenesis to refute commonly held assumptions about its prevention.

Open versus closed surgical treatment of abscesses: a controlled clinical trial.

BACKGROUND: Conventional drainage, curettage and packing of acute superficial abscesses has been challenged and in some centres replaced by curettage and primary closure under antibiotic cover. This technique has not been used widely in Australasia or North America, probably because of the lack of reassurance from local randomized trials. METHODS: A randomized trial was conducted to compare the primary closure of acute superficial abscesses to conventional packing. Abscesses requiring drainage under a general anaesthetic were considered for the study, excluding extensive, secondary and deep suppurations. In the 'open' group, the abscess was drained, curetted, irrigated, and then packed. Instead of packing, the cavity in the 'closed' group was obliterated using interrupted vertical mattress skin sutures with/without closed suction drainage. Other aspects of management were standardized. RESULTS: Of the 32 abscesses treated using the closed technique, 25 (78%) healed by primary intention after 1 week (SE(p) = 7.3%; 95% CI = 63.7-92.4%). One of the 29 abscesses (3%) treated using the open technique healed by secondary intention in a similar period of time. The difference was statistically significant (Chi-squared test with Yates' continuity correction = 31.70; P < 0.0001). There was no statistically significant difference in the overall incidence of healing, 1 month after surgery (chi 1(2) = 0.07; P > 0.9). In the closed group, healing was obtained by primary intention, leaving a linear surgical scar in 84% of the cases (SE(p) = 5.7%; 95% CI = 72.8-95.2%). Hospitalization and the need for analgesia and dressing changes were reduced by 40-60%. CONCLUSIONS: Primary closure of acute superficial abscesses was associated with an improved outcome in terms of duration and quality of healing, postoperative pain, length of hospitalization, nursing care and, by implication, cost, and may be recommended as an alternative treatment that is superior to the orthodox technique.

The movement of mucosal cells of the gallbladder within the peritoneal cavity during laparoscopic cholecystectomy.

BACKGROUND: Tumor dissemination to trocar sites following the removal of a gallbladder malignancy by laparoscopic cholecystectomy is well documented. The mode of transfer of malignant cells to those sites remains unclear. METHODS: The appearance and movement of gallbladder mucosal cells within the peritoneal cavity during laparoscopic cholecystectomy was prospectively studied in 15 patients. The appearance of cells on laparoscopic instruments, laparoscopic working ports, and also within a 5-microm polycarbonate filter, filtering exhaust carbon dioxide and attached to one of the main working ports, was noted. RESULTS: Four out of 15 gallbladders were perforated during cholecystectomy. Operative choledochography was performed in 11 of the 15 cases. Glandular cells were found on instruments at the end of the procedure in six cases. Cells were also found in two of the 15 polycarbonate filters and on the laparoscopic ports in two of the 15 cases. CONCLUSION: These findings suggest that cellular contamination of the peritoneal cavity is frequent during laparoscopic cholecystectomy. This may occur when the gallbladder wall is macroscopically breached or when operative choledochography is performed, or by microperforation due to the application of crushing laparoscopic graspers to the gallbladder wall. Glandular cells adhere to instruments in 40% of the operative procedures and may be the main source of dissemination of malignant cells through the peritoneal cavity.

Child accident-mortality in the Northern Territory, 1978-1985.

The mortality in children who were aged 0-14 years in the Northern Territory in 1983-1985 was 2.5-times higher than it was for Australia generally over the same period. Total accidental-death rates over the period 1979-1983 in Aboriginal children were 2.2-times higher than in non-Aboriginal children. A trend towards an excess in Aboriginal child mortality was present in most categories except drowning and was particularly noteworthy for deaths due to natural and environmental causes (predominantly caused by box-jellyfish stings). Non-Aboriginal children experienced higher rates of death due to drowning than they did elsewhere in Australia; most of these occurred in domestic swimming-pools. A higher mortality was encountered in rural areas. The pattern of motor-vehicle-related deaths differed between Aboriginal children and non-Aboriginal children, with the former experiencing a greater number of deaths due to non-collision accidents that involved "loss of control". The implications of these findings for the development of appropriate preventive strategies is discussed.