Ann R Coll Surg Engl 2005; 87: 427-431 427The annual incidence of stoma formation in England is 20,800, 1 although recent literature would suggest that this figure is unnecessarily high. The management of obstructing left-sided colorectal cancer has changed in recent times, with increased use of on -table lavage with primary resection and anastomosis 2,3 and colorectal stenting 4 to avoid stoma formation. Sphincter preserving surgery for rectal cancer should also reduce permanent stoma rates. 5Persistently high morbidity and mortality rates associated with stoma creation and reversal are behind attempts to reduce their formation. Long-term complication rates of 58% in colostomies 6 and up to 76% in ileostomies 7 have been reported. It is also recognised that around 15% of temporary stomas created at the time of anterior resection become permanent. 8There has been much recent work examining risk factors for mortality in colorectal cancer surgery, 9 such as ASA grade and age, but whether the presence of a stoma affects mortality has not been previously examined. Studies have addressed the mortality following stoma reversal (0-4%), 10 but the literature is scant when stoma creation is concerned.We have examined whether the incidence of stoma formation is declining in the practice of a typical district general hospital, and investigated the prevalent morbidity and mortality associated with stoma creation, together with their risk factors. Patients and MethodsAll patients undergoing colostomy or ileostomy formation (elective and emergency) from January 1992 to December 2000 were identified. Data were collected from patient records maintained prospectively by the stomatherapy department, supported by information from operation notes and patient case records. Complications recorded were necrosis, prolapse, peristomal infection or abscess, retraction, stenosis, parastomal hernia, fistula and malignant change at the stoma site.Complications not included were skin excoriation and laparotomy wound problems.Operations were performed by one of seven consultant general surgeons or their registrars, three of whom had a declared interest in coloproctology. Patients undergoing bowel resection without stoma formation were not studied. Statistical analysisResults are expressed as the mean (SD) Stoma Care, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, Mid-Glamorgan, UK ABSTRACT INTRODUCTION As stoma formation is thought to be declining, we performed a study to evaluate the rate of stoma formation and the impact on stoma complication rates, together with risk factors for complications.

Laparoscopic cholecystectomy is one of the most commonly awaited general surgical procedures in the UK. However, many patients awaiting a cholecystectomy are admitted with recurrent gallstone related symptoms while on the waiting list, resulting in significant morbidity. The aim of this study was to quantify this problem, and also to analyse the cost implications of these admissions for the NHS. A retrospective study was performed of all patients who underwent an elective cholecystectomy by three consultants in a district general hospital between January 1999 and January 2000. The demographic details, indications for surgery, details of the emergency admissions while on the waiting list, and the treatment given during these episodes were recorded. One hundred and fifty six patients were included in the study, of which 122 (78%) were females. The mean (SD) age of the patients was 54 (5) years. The mean waiting time for surgery in these patients was 12 (3) months. Thirty seven patients (23.7%) were admitted as an emergency due to gallstone related symptoms and complications while awaiting surgery. There were 47 episodes of admissions in total, of which 32 were for biliary colic, 13 were for acute cholecystitis, and two were for acute pancreatitis. In addition to routine blood tests, 20 abdominal radiographs, 10 chest radiographs, three endoscopic retrograde cholangiopancreatography tests, five ultrasonograms, and one computed tomogram were carried out in these patients. The mean duration of each episode of admission was three days. The cost of treatment per episode was £946 and the total cost of treating the 37 patients was calculated to be £44 462. Performing early laparoscopic cholecystectomy for acute cholecystitis may help to reduce costs by preventing recurrent emergency admissions in these patients. Further studies to identify risk factors associated with recurrent symptoms and complications in patients with gallstone disease may help to prioritise them for early surgery. P atients with gallstone disease make up a significant percentage of those awaiting elective surgical procedures. Many of these patients are admitted as an emergency with recurrent gallstone related symptoms. In addition to the morbidity, significant costs are involved in treating these patients.Our aims were to study the incidence of emergency inpatient admissions because of gallstone related problems among those awaiting an elective cholecystectomy, and to assess the direct NHS costs involved in treating these patients. METHODSA retrospective analysis was performed of all the patients who underwent an elective cholecystectomy by three consultants in a district general hospital between January 1999 and January 2000. Data were collected on demographics, the duration of the waiting time, the specific indications for including the patients in the waiting list, details of emergency admissions while awaiting surgery, and the investigations and treatment given during these episodes. RESULTSA total number of 156 patients underwent elective cholec...

Athletes' groin pain may be due to nerve entrapment in the external oblique aponeurosis. An awareness of this injury may reduce delays in operating leading to an earlier return to sport.

Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate.

The management of undescended testes remains variable, and the use of laparoscopy for localisation is controversial. This study reviews the need for laparoscopy and also assesses the current practice among a cohort of surgeons.A retrospective review of all patients undergoing orchidopexy was performed, together with a postal survey of all members of the Welsh Surgical Society.Of the 139 orchidopexies performed, the testis was deemed impalpable in 39 (28%) cases. All patients were treated with groin exploration, and only in two (5%) patients was the testis not located. From the survey, replies were received from 90 (81%) surgeons, of whom 65 (72%) were still performing orchidopexy. Forty eight (74%) surgeons performed orchidopexy between the age of 2 and 3, and only 32 (36%) performed preoperative investigations. The follow up period was variable with the majority of patients seen at six weeks.Laparoscopy for the impalpable testis is not initially warranted. An inguinal exploration is regarded as the definitive investigation. This has the advantage of providing the diagnosis and treatment in the majority of cases. (Postgrad Med J 2001;77:320-322) Keywords:cryptorchidism; impalpable testis; orchidopexy; laparoscopy Cryptorchidism means hidden or obscure testis, and is generally synonymous with an undescended testis. Of newborn boys, between 1% and 3% have an empty scrotum, 1 thus making cryptorchidism one of the most common surgical disorders in childhood. Although its aetiology is unclear, the definitive treatment for true undescended testes is surgical placement into the scrotum, thereby improving fertility and decreasing the malignant potential.The majority of cryptorchid testes are palpable but incompletely descended into the scrotum. As many as a third of these testes will likely be retractile when examined.2 However, the non-palpable gonad constitutes 20% of all cases.3 It may be located anywhere between the upper scrotum and abdomen, or may even be absent. Accurate preoperative localisation of the non-palpable testes has been diYcult, and its need disputed. We conducted a study to answer the question: was groin exploration a correct method for diagnosis and treatment of the impalpable testis, or is laparoscopy indicated? We set out to look at our own experience and also to evaluate the current practice within a cohort of surgeons. Subjects and methodsThe first part of this study was a retrospective review of a single consultant's (MEF) experience of all patients who underwent orchidopexy between June 1991 and August 1997. The surgeon was a general surgeon who had a special interest in paediatric surgery, and worked in a district general hospital. These patients were identified from clinical coding and theatre registers. Orchidopexy for reasons other than undescended testes were excluded. Case notes were reviewed for details of age, side of undescended testis, preoperative palpability, and the type of operation performed.The second part was a survey comprising a single sheet questionnaire (appendi...