Background Laparoscopic sigmoid resection is a feasible and frequent operation for patients who suffer from recurrent diverticulitis. There is still an ongoing debate about the optimal timing for surgery in patients who suffer from recurrent diverticulitis episodes. In elective situations the complication rate for this procedure is moderate, but there are patients at high risk for perioperative complications. The few identified risk factors so far refer to open surgery. Data for the elective laparoscopic approach is rare. The objective of this study was to identify potential predictive risk factors for intra-and postoperative complications in patients who underwent laparoscopic sigmoid resection due to diverticular disease. Methods Uni-and multivariate analyses of a prospectively gathered database (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) were performed on a consecutive series of 526 patients who underwent laparoscopic sigmoid resection due to recurrent diverticulitis in a single institution. Patients were assessed for demographic data, operative indications, and intra-and postoperative complications. Altogether, we analyzed 17 potential risk factors to identify significant influence on the intra-and postoperative outcome, including timing of surgery. Results Statistical analysis of specific medical and surgical complications revealed anemia, previous myocardial infarction, heart failure, experience of the surgeon, and male gender, as independent predictive risk factors for postoperative complications. Patients older than age 75 years was the only independent risk factor for intraoperative complications in a multiple logistic regression model. Early elective surgery led to increased conversion rate but did not influence the postoperative complication rate. Conclusions This large, single-center study provides first evidence of the significance of specific predictive risk factors for intra-and postoperative complications in laparoscopic sigmoid resection for diverticular disease.

Background Surgical site infections (SSI) remain one of the most common complications in conventional abdominal surgery with an incidence between 4% and 19% (Sandini et al., Medicine (Baltimore) 95:e4057, 2016) in the literature. It is unclear whether the use of coated suture material for skin closure reduces the risk of SSI. In line with in-vitro results, we hypothesize that the use of antibacterial skin sutures (triclosan-coated poliglecaprone 25) reduces the rate of SSI after open abdominal surgery. Methods/design To prevent SSI, triclosan-coated poliglecaprone 25 sutures will be tested against un-coated suture material for skin closure after elective open abdominal surgery of 364 patients. The study is planned as a single-center, prospective randomized controlled trial. Patients will be followed for 30 days after surgery to detect and document wound complications. The rate of SSI after 30 days will be analyzed in both groups. Discussion If we can confirm the proposed hypothesis in our study, this could be a promising and feasible approach to lower SSI after open abdominal surgery. By lowering the rate of SSI this might offer a cost-saving and morbidity-reducing procedure. Trial registration German Clinical Trials Register, DRKS00010047 . Registered on 05.01.2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3492-3) contains supplementary material, which is available to authorized users.

Dear editor: Elective liver surgery has become safe and feasible in the recent decades. Nevertheless, biliary leakages or strictures, hepatic insufficiency or abscess formation, vascular complications, pleural effusion, and thromboembolic events are most feared early postoperative complications.Cecum perforation caused by bowel herniation through a defect of the right diaphragm after hepatic surgery is a very rare, most likely long-term complication that should be immediately diagnosed and treated surgically.A 67-year-old man was admitted suffering from epigastric pain for 5 days. Additionally, he reported distension of the abdomen, constipation, and spasmodic hiccup. Three years before, a carcinoma of the sigmoid colon and synchronic hepatic metastasis were diagnosed. Therefore, he underwent open rectosigmoid resection followed by chemotherapy according to FOLFOX4 pattern. After partial remission of the hepatic metastasis, right hemihepatectomy was performed. Having multiple pulmonary metastases in late 2005, chemotherapy to SALTZ pattern was once more performed. After stable disease until December 2006, palliative second-line chemotherapy (FOLFIRI pattern) was started.Clinical examination revealed a diffuse painful and meteoristic abdomen with local tenderness in the right upper abdomen, decreased bowel sounds, and moist rales in the lower chest. Furthermore, the patient presented with typical signs of septic status, as leukopenia, arterial hypotension, and tachycardia were seen.Due to suspicion of transdiaphragmatic herniation in the chest X-ray, computed tomography (CT) was performed that revealed a right-sided enterothorax with a broad hint of colonic incarceration in the diaphragm, accompanied by cecum distension.An immediate emergency operation was carried out with resection of the right hemicolon. The cecum was perforated and partially necrotic due consecutive distension while right colonic flexure was incarcerated in the right diaphragm. The diaphragmatic defect was situated in right anterior aspect of the caval vein in the central tendon of the diaphragm and was closed by running suture.Undergoing several reoperations including side-to-side ileotransversostomy and abdominal wall reconstruction, final closure could be performed 26 days after emergency surgery. The patient recovered well and was discharged from the hospital after 45 days.Of all diaphragmatic hernias, the incidence of right diaphragmatic hernia is about 11-14%. Spontaneous nontraumatic ones are very rare. Typical reasons are blunt or penetrating injuries on one hand. On the other hand, congenital defects of the diaphragm are basic causes. Transdiaphragmatic herniation after hepatic surgery, however, is rarely reported. A few cases have described this entity after liver transplantation or right living donor hepatectomy.A possible reason for the diaphragmatic defect could be a thermal damage of the diaphragm caused by an argon beamer or any other surgical instrument used for liver resection the patient underwent prior. Diaphragmatic heat le...

Leukocyte alkaline phosphatase (LAP) activity was studied in 50 women at delivery and in the newborn after delivery. The foüowing findings were observed: (1) the LAP activity of newborns is lower than that of the mothers; (2) significant decrease in the LAP activity has been observed in newborns on the 4th day after delivery; (3) there are no significant differences between newborns from normal and prolonged labor; (4) immediately after delivery the LAP scores of male newborns are lower than those of females, but 4 days later these scores were reversed, and (5) 4 days after delivery, the LAP scores do correlate to the weight of the newborn.

Necrotizing fasciitis (NF) is a serious and potentially life threatening soft tissue infection, usually caused by different types of bacteria such as group A streptococcus, staphylococcus spp. (type 1 infection) or mixed infection by aerobic and anaerobic bacteria (type 2 infection). Usually, the infection arises from skin injury, in injections or surgical procedures and effects the fascia as well as the subcutaneous tissue. Overwhelming progression and difficulties in diagnosing are very common. Mortality rate is up to 100% depending on the type of soft tissue infection and did not markedly decrease in the past decades [1]. Here we present a case of NF with fatal outcome following colonoscopy, which was primarily suspected to be a post polypectomy syndrome.

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Abdominal wall hernias, in particular inguinal hernias are the most frequently encountered entity in general surgery. Consequently, the socio-economic burden results from the in-hospital phase itself and to a considerable extent from the convalescence period. In addition to the surgical procedure and the occupation of the patient there are two factors of particular significance influencing the aftercare: the post-operative pain and the given recommendations for postoperative strain. Next to patient-factor adapted operative procedures it is therefore essential, to offer a standardized pain management and recommendations for postoperative strain. Currently there is no conclusion, whether the minimally invasive techniques will be established as the "Gold-standard", particularly from an economic point of view and the introduction of the DRG in Switzerland.