Epidemiologic data suggest that the incidence of C. difficile infection is increasing in U.S. surgical patients and that the infection is most prevalent after emergency operations and among patients having intestinal tract resections. Infection with C. difficile is an independent predictor of increased LOS, total charges, and mortality rate after surgery and represents a considerable burden to both patients and hospitals. Preventing C. difficile infection offers a potentially significant improvement in patient outcomes, as well as a reduction in hospital costs and resource expenditures.

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In any collaborative endeavor, when fields like medicine and bioengineering overlap, the proper use of technical vocabulary takes on added importance. It is important that scientists and clinicians, while coming from different backgrounds and educational systems, agree upon and utilize a common language based on mutually understood concepts and definitions. Regarding biomaterial testing applications, numerous terms are used to describe a wide variety of material behaviors when test specimens are subjected to mechanical, chemical, electrical and thermal stressors. In this discussion we will limit ourselves to the mechanical properties of materials which are utilized for soft tissue or fascial-based repairs. Following a literature search combining the keywords surgical mesh and biomaterials testing, common terms used to describe the mechanical properties of mesh were selected. Our analysis seeks to define the following terms and describe their applicability within the context of biomaterials for hernia repair: elasticity, stiffness, flexibility, tensile strength, distension, deformation, bending stiffness, and compliance. Unfortunately, in the technical literature, terms are often altered or extrapolated without adequate explanation. In other cases, related but technically different terms are mistakenly used interchangeably. With the mounting interest in biomaterials for the use in repair of abdominal wall defects, there is a need to standardize the terminology used to describe the biomechanical properties of mesh.

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Our data suggest that colonoscopy can be safely and successfully performed in the very elderly. In patients with symptoms or suggestive radiographic findings, cancer was detected in 4.0%-60% of cases. No cases of cancer were discovered in those patients who were asymptomatic.

Adhesions from prior surgery are the most common cause of small bowel obstruction (SBO) in the Western world. Although laparoscopic adhesiolysis can be performed safely and effectively, the indications and contraindications to the use of laparoscopic techniques in SBO are not clearly defined. The goal of our study was to determine the outcomes of the laparoscopic approach to SBO and discuss patient considerations for its utilization. We retrospectively surveyed all patients undergoing laparoscopic or attempted laparoscopic adhesiolysis performed by the authors between July 1997 and March 2006. Data obtained included patient demographics, clinical and radiologic presentation, and intraoperative and postoperative course. Thirty-three patients underwent laparoscopic adhesiolysis secondary to a SBO. Mean age was 53.6 years (range, 29–84 years) and 64 per cent (21 of 33) were female. Mean body mass index was 30.0 kg/m2 (range, 22.6–46.1 kg/m2). Thirty-one patients (93.9%) had undergone between one and four abdominal surgeries and seven (21.2%) had a previous episode of SBO. There were no patients with peritonitis. Abdominal CT scan was performed preoperatively in 27 patients (81.8%). Laparoscopy diagnosed the site of obstruction in all patients. Twenty-nine patients (88%) were successfully treated laparoscopically. Conversion to laparotomy was required in four cases as a result of dense adhesions and/or a lack of working space. Mean procedural time was 101 minutes (range, 19–198 minutes). There was one intraoperative complication (enterotomy), which was repaired laparoscopically and did not require conversion. Conversion was associated with significantly increased procedural time (129 versus 93 minutes; P = 0.02), but not blood loss or complications. Average times to passage of flatus and first bowel movement were 2.3 days (range, 0.5–5 days) and 3.2 days (range, 1–6 days), respectively. Seven patients (21.2%) had postoperative complications, including wound infection, urinary tract infection, and acute renal insufficiency, all of which occurred in patients completed laparoscopically. One patient had a recurrent SBO 8 months postoperatively managed by repeat laparoscopic lysis of adhesions. Mean postoperative stay was 6 days (range, 1–19 days). There was no hospital mortality. Laparoscopy is safe and feasible in the management of acute SBO in selected patients. It is an excellent diagnostic tool and is therapeutic in most cases.