This study demonstrated the presence of irritant, carcinogenic and neurotoxic compounds in electrosurgical smoke. This may have considerable implications for the health and safety of all involved in surgical practice, as exposure to these compounds pose potential risks to health.

Hospital healthcare workers (HCWs) are at increased risk of contracting COVID-19 infection. We aimed to determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in HCWs in Ireland. Two tertiary referral hospitals in Irish cities with diverging community incidence and seroprevalence were identified; COVID-19 had been diagnosed in 10.2% and 1.8% of staff respectively by the time of the study (October 2020). All staff of both hospitals (N = 9038) were invited to participate in an online questionnaire and blood sampling for SARS-CoV-2 antibody testing. Frequencies and percentages for positive SARS-CoV-2 antibody were calculated and adjusted relative risks (aRR) for participant characteristics were calculated using multivariable regression analysis. In total, 5788 HCWs participated (64% response rate). Seroprevalence of antibodies to SARS-CoV-2 was 15% and 4.1% in hospitals 1 and 2, respectively. Thirty-nine percent of infections were previously undiagnosed. Risk for seropositivity was higher for healthcare assistants (aRR 2.0, 95% confidence interval (CI) 1.4–3.0), nurses (aRR: 1.6, 95% CI 1.1–2.2), daily exposure to patients with COVID-19 (aRR: 1.6, 95% CI 1.2–2.1), age 18–29 years (aRR: 1.4, 95% CI 1.1–1.9), living with other HCWs (aRR: 1.3, 95% CI 1.1–1.5), Asian background (aRR: 1.3, 95% CI 1.0–1.6) and male sex (aRR: 1.2, 95% CI 1.0–1.4). The HCW seroprevalence was six times higher than community seroprevalence. Risk was higher for those with close patient contact. The proportion of undiagnosed infections call for robust infection control guidance, easy access to testing and consideration of screening in asymptomatic HCWs. With emerging evidence of reduction in transmission from vaccinated individuals, the authors strongly endorse rapid vaccination of all HCWs.

IrelandCorrespondence to: Mr R. 6. Stephens The arrival of videoendoscopy has facilitated a wide range of endoscopic operative procedures across a variety of surgical disciplines, including gynaecology, otorhinolaryngology, orthopaedics and most recently general surgery. Laparoscopic cholecystectomy is currently the most common major abdominal operation performed endoscopically . Increasing familiarity with this new technique has resulted in a growing list of operations that can be performed with the aid of the laparoscope. The first laparoscopic approach to performing Meckel's diverticulectomy for acute inflammation is described. TechniqueA 28-year-old man with a previous appendicectomy presented with acute abdominal pain. A diagnostic laparoscopy was performed using a 10-mm trocar inserted below the umbilicus and a 5-mm trocar in the right iliac fossa. This revealed a swollen and inflamed Meckel's diverticulum. The diverticulum and its attached loop of small intestine were brought onto the surface of the abdominal wall (Figure 1 ) by pulling the diverticulum into the 10-mm trocar at the umbilicus and then removing the trocar from the abdominal cavity. A 3-mm extension to the incision was required to allow the loop of small intestine to come onto the surface. With the loop so exteriorized (Figure 2), the Meckel's diverticulum was then simply removed using a TA55 stapler (Auto Suture, Dublin, Ireland ) and the small bowel was replaced into the peritoneum. The two wounds were closed with subcuticular absorbable sutures. The patient recovered full mobility the following day and was discharged home on a normal diet on the third day after operation. Histology confirmed the presence of an acutely inflamed Meckel's diverticulum, containing gastric-type epithelium. DiscussionThe advantages of laparoscopy over laparotomy include rapid recovery of full muscle function and the lack of postoperative pain. In this patient, the laparoscope was used to make a diagnosis and to facilitate a standard operation by exteriorizing the relevant segment of small intestine. With the introduction of laparoscopic stapling devices, Meckel's diverticulectomy could be performed entirely within the peritoneal cavity under laparoscopic control, but this would probably not confer any great advantage over the procedure adopted in this case. The use of diagnostic laparoscopy is recommended in all patients with atypical abdominal pain for the purposes of establishing an accurate diagnosis and to perform definitive surgery where feasible. ReferencesOlsen DO. Laparoscopic cholecystectomy. Am J Sury 1991 ; 161 : 339 -44.

A prospective study into the aetiology of acute food bolus obstruction (AFBO) was carried out on 17 consecutive patients who presented with this complaint. There were nine males and eight females. Twelve patients (71 per cent) had symptoms of oesophageal disease and 10 patients (59 per cent) had prior food bolus obstruction. Investigations included endoscopy, barium swallow, oesophageal pH and manometry studies. Evidence of oesophageal pathology was found in 12/14 (86 per cent) of patients investigated. No patients had malignancy and the most common abnormality, gastroesophageal reflux (GOR) was found in eight out of 14 (57 per cent) of cases. Oesophageal dysmotility was seen in five out of 12 (42 per cent) patients who had manometric studies.With such a high incidence of recurrence of AFBO, we suggest that patients with this condition be investigated to exclude malignancy and to identify benign oesophageal pathology using techniques such as oesophageal pH and manometry. Appropriate treatment of oesophageal disease may help prevent recurrence of this distressing condition.

TEP repair is feasible in patients with previous lower abdominal surgery. TEP was planned as a day-case procedure; however, patients with recurrent hernias needed a planned admission, as an overnight stay was required.