Introduction The National Bowel Cancer Screening Programme guidelines advocate the use of endoscopic tattooing for suspected malignant lesions to assist identification and to facilitate laparoscopic resections. However, endoscopic tattooing practices are variable in endoscopic units, resulting in re-endoscopy and delay in patient management. The aim of this study was to assess the adherence to tattoo protocol for significant colonic lesions at an endoscopy unit in a large district general hospital. Materials and methods Prospectively collected data were analysed for 252 patients with significant colonic lesions between January 2017 and December 2018. Data were collected through reviewing patient’s notes, histopathology findings and endoscopy reports. Data on lesions, complications, number and site of tattoo placed, and any repeat endoscopy for a tattoo were collected. Results Of the 252 patients, 88% (n = 222) had malignant and 12% (n = 30) had benign lesions. Only 58.7% (n = 148) of those patients who had colonoscopy had tattoo placement reported. Of these 148 cases, the report stated the distance of tattoo in relation to the lesion in only 46% (n = 68) of patients. Unfortunately, 14.3% (n = 36) of patients required re-endoscopy to tattoo the lesions prior to surgery. Conclusions Our study highlights the lack of uniformity of tattoo practice among endoscopists. Despite the National Bowel Cancer Screening Programme guidelines, a significant proportion of colorectal lesions are still not tattooed during their first endoscopy. Some patients had to have repeat endoscopy just for the purpose of tattooing. Active involvement and participation of all endoscopists in the colorectal and the complex polyp multidisciplinary teams may help to improve the tattoo service.

Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of emergency surgery. A prospective observational study was performed between March 30, 2020, and June 30, 2020, at a large District General Hospital in England. The primary outcome was perioperative COVID-19-related complications, and secondary outcome measures included incidence of COVID-19 infections among the acute surgical patients, doctors, and healthcare workers. A total of 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors and 11 theater staff were confirmed for COVID-19 by swab test. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge, but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.

Objective: Inguinal hernia repair is one of the most common general surgical procedure, and laparoscopic approach gained popularity over the open approach. This study aimed to compare the clinical effects of TEP inguinal hernioplasty with or without mesh fixation. The primary outcome was acute post-operative pain. Material and Methods: A retrospective comparative study on a prospectively collected data was conducted in a large DGH in England between Janu- ary 2017 and December 2019 on 47 patients. The patients were divided into two groups. In group A, mesh fixation was performed with absorbable tackers and in group B no fixation was performed. Patients were followed up to 18 months postoperatively. Data was collected on post-operative pain, cost, recurrences and time taken to return to normal activities. Patients with lower midline scar and complicated inguinal hernias were excluded. Results: Out of the 47 patients 53% (n= 25) were in group A and 47% (n= 22) in group B. All the patients in both groups were male. The mean postopera- tive pain score at 72h in group A was 7.12 (SD 1.13) and 4.91 (SD 1.23) in group B (p< 0.001). Group B patients have taken shorter time to return to normal activities in comparison to group A (p< 0.001), while recurrence (2%) rate is higher in group B (p> 0.05). Conclusion: Pain and time taken to return to normal work postoperatively were significantly less in the non-fixation group. The study recommends non-fixation over fixation as it is feasible, cost-effective, causes less post-operative pain and no differences in terms of recurrences.

De Garengeot hernia describes a rare phenomenon in which a vermiform appendix is found in a femoral hernia sac. We describe a case of De Garengeot hernia presenting as a groin lump associated with loss of appetite, weight loss and fatigue. A 72-year-old woman was referred to our rapid access 2-week clinic as isolated lymphadenopathy with a 4-week history of a gradual right groin swelling accompanied by an unintentional weight loss, lethargy and anorexia. An urgent excisional lymph node biopsy was performed preceding the CT scan of the chest, abdomen and pelvis. The biopsy showed a shaving of appendix wall, and the CT scan revealed a right-sided femoral hernia with appendix as its content. The patient was urgently contacted for a laparoscopic appendicectomy and an open right femoral hernia repair. The patient recovered well postoperatively, and her systemic symptoms fully resolved when reviewed 10 weeks after the operation.

Background Transmission of COVID-19 is a considerable risk during the perioperative period of emergency surgery. We aimed to provide a practical experienced adaptation to reorganize the emergency surgical pathways during the COVID-19 pandemic. Methods A prospective observational study was performed between 30th March 2020 to 30th June 2020 at a large DGH in England. The primary outcome was perioperative COVID-19 related complications and secondary outcome measures included incidence of COVID-19 infections among the surgical doctors and healthcare workers. Data was collected on the number of acute surgical admissions and operations performed. The perioperative COVID-19 status of the patients, doctors and the healthcare workers were recorded. Results 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted with COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors, 11 nurses and theatre staff were confirmed for COVID-19 by swab test. Acute cholecystitis and early appendicitis were managed conservatively. Conclusion High mortality (20%) observed among the patients who contracted COVID-19 perioperatively. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.