The laparoscopic approach to Nissen fundoplication improved early postoperative recovery, with an equally good outcome up to 12 months.

T‐tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T‐tube drainage of the CBD following exploration for calculous disease. Thirty‐seven patients underwent primary closure and 26 underwent closure over T‐tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre‐operative bilirubin, amylase and white cell count. Forty‐three per cent of operations were performed by a consultant in the primary closure group and 65% in the T‐tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T‐tube group, to a median of 11 days, compared to 8 days in the primary closure group (P= 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T‐tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long‐term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T‐tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation. Primary closure of the CBD following exploration for calculous disease significantly reduces hospital stay, and is as safe as closure with T‐tube, in both the short and long‐term.

A variety of conservative and surgical options are available in the management of para‐oesophageal hiatus hernia. However opinion is divided in regard to the best form of treatment. A series of 71 patients with para‐oesophageal hiatus hernia has been studied, to assess hospital management and outcome after treatment. Case notes of all patients were reviewed, and a questionnaire sent to surviving patients. Of those patients treated surgically with an anatomical repair plus a fundoplication, 19% had recurrence of significant symptoms. In contrast, 55% of patients managed by an anatomical repair alone had recurrence of significant symptoms. Conservative management was undertaken in 29 of the 71 patients and 66% had recurrence of significant symptoms, with 13 proceeding to elective surgery. Nevertheless, there is a place for the conservative management of para‐oesophageal hiatus hernias. Para‐oesophageal hernias are usually combined type hernias with associated reflux symptoms and repair of the hernia should include an antireflux procedure.

General surgeons undertake a substantial number of procedures across a broad spectrum of emergency neurosurgery in Darwin. Outcomes following surgery appear acceptable.