AIM:To assess the use of topical negative pressure (TNP) in the management of severe peritonitis. METHODS:This is a four-year prospective analysis from

Glue fixation of mesh for open inguinal hernioplasty is superior in many outcomes including the reduction of chronic groin pain. Glue fixation was not associated with an increased risk of hernia recurrence.

Should colorectal surgeons perform laparoscopic cholecystectomy in a district general hospital?a ns_5293 304..309 A recent national audit on the management of gallstone disease in England showed that only 15% of acute admissions underwent emergency laparoscopic cholecystectomy (LC). 1 Another English audit suggested improved outcome and lesser complications if upper gastrointestinal surgeons performed gall bladder surgery. An identical trend was noted in Scotland. 2 These reports add to the ongoing debate regarding subspecialization. Currently, more than 45 000 gall bladder operations are performed in the UK every year by both general and specialist surgeons. 3 The aim of this study was to evaluate the results of LC performed by colorectal surgeons (CRS) and non-colorectal surgeons (NCRS) in a district general hospital (DGH). The NCRS included general and upper gastrointestinal surgeons.Patient data were collected prospectively between 1 April 2003 and 31 March 2008, and analysed by SPSS version 17.0 statistical package (SPSS, Chicago, IL, USA). Demographic details, conversion rate, emergency procedures and complications were recorded. Surgeons were grouped into CRS who predominantly performed elective colorectal surgery including laparoscopic colorectal procedures. The rest were general surgeons or upper gastrointestinal surgeons who performed largely general surgery or elective upper gastrointestinal surgery. All surgeons in this hospital take part in emergency on-call rota. Significance of difference was evaluated by chi-square test and a P-value < 0.05.During this period, 2011 patients underwent LC. Of those, 488 were emergency and 1523 were elective procedures. Median age, sex and length of hospital stay were shown in Table 1. There was no difference in length of stay between the two groups (CRS versus NCRS) in either elective or emergency operations. The overall conversion rates in elective and emergency procedures were 6.9% and 14.5%, respectively. A conversion rate in elective LC by CRS was 7.5%, whereas the conversion rate by NCRS was 7%. In emergency surgery it was 17.6% and 12.2%, respectively. None of these differences were statistically significant. There was a steady rise in the PERSPECTIVES ANZJSurg.com