Routine blood group and antibody screening prior to emergency laparoscopy.

Introduction Studies show that rates of blood transfusion associated with general surgical laparoscopy are low. Currently, there are no national guidelines in the UK regarding blood group and antibody screening (G&S) for patients undergoing emergency laparoscopy. The aim of this study was to assess whether using G&S before emergency laparoscopic general surgery routinely is worthwhile by identifying rates of perioperative transfusion. Methods Data were collected retrospectively on all emergency laparoscopic procedures at a single district general hospital between January 2014 and 31 December 2016. Emergency laparoscopic general surgical cases were included and gynaecological cases excluded. Records were reviewed to ascertain whether G&S was performed, whether antibodies were detected and whether patients were transfused. Results A total of 562 emergency laparoscopic cases were performed. The median age was 28 years (range: 6-95 years). Laparoscopic appendicectomy (n=446), diagnostic laparoscopy (n=47) and laparoscopic cholecystectomy (n=25) were the most common procedures. Of the total patient cohort, 514 (91.5%) and 349 (70.1%) had a first and second G&S respectively while 30 (5.3%) had no G&S. Four patients (0.71%) had antibodies detected. One patient (0.18%) received a transfusion. This patient had undergone laparoscopic repair of a perforated duodenal ulcer and there was no major intraoperative haemorrhage but he was transfused perioperatively for chronic anaemia. Conclusions These results demonstrate a low rate of blood transfusion in emergency laparoscopic general surgery. The majority of these patients had a low risk of major intraoperative haemorrhage and we therefore argue that G&S was not warranted. We propose a more targeted approach to the requirement for preoperative G&S and the use of O negative blood in the event of acute haemorrhage from major vessel injury.

An additional strip of mesh minimizes hernia recurrence after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. An analysis of 490 cases over 10 years.

AIM: The laparoscopic inguinal hernia repair has gained significant interest over the years as an alternative to the conventional open technique as a result of its faster recovery time, reduced postoperative pain and numbness. However the recurrence rates are in the order of 2.3% compared to the 1.3% quoted for the equivalent open approach. Much of these recurrences occur either caudal to the fold created in the mesh once in-situ or lateral to the border of the mesh. This technique aims to address both these areas of concern using an additional strip of mesh across the centre to brace the mesh and create a bolster to maintain mesh stability. METHODS: The technique involves cutting a 2 cm strip from the 15x15 cm mesh which is laid length-ways over the remaining 13x15 cm mesh, keeping the longest dimension in the medial to lateral plane, and loosely tacked. The strip over hangs the lateral border of the mesh to control the lateral space. Recurrence rates were evaluated from a prospectively collected data series as well as outcomes collected from a questionnaire over a 10 year period between January 2001 and October 2011. Primary outcomes were confirmed hernia recurrence requiring surgical repair. RESULTS: Four hundred ninety-one patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with outcomes including recurrence rates were retrospectively examined through a prospectively collected database. Subsequently 400 patients were sent a validated questionnaire. 246 responded (62% response rate). One recurrence (0.3%), which occurred 4 years after the original laparoscopic repair, was described across the series. CONCLUSION: The use of the additional mesh strip potentially reduces TEP hernia recurrence rates beyond simply the benefits of the learning curve. Although, questionnaires are notoriously inaccurate, the value and consistency between both evaluation techniques suggests that this level of reduction is significant to warrant further prospective trials.

Embolisation of an acute inflammatory pulmonary artery aneurysm using an Amplatzer® vascular plug.

Pulmonary artery aneurysms (PAA) are rare. To date there are no cases in the literature describing formation secondary to oesophageal perforation. We present an unusual case of ruptured inflammatory segmental PAA. A patient with oesophageal squamous cell cancer presented with shortness of breath and sepsis following endoscopic dilatation of an oesophageal stricture. Imaging demonstrated oesophageal perforation and a pulmonary parenchymal collection containing an inflammatory PAA. Following initial conservative management, he then re-presented with haemoptysis secondary to PAA rupture. He was treated with embolisation using an Amplatzer® vascular plug (AVP) and went on to make an uneventful recovery.