Small bowel obstruction (SBO) accounts for 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. Even with the advent of laparoscopic surgery, intra‐abdominal adhesions remain a significant cause of SBO, accounting for 65% of cases. History and physical examination are essential to identify signs of bowel ischemia as this indicates a need for urgent surgical exploration. Another critical aspect of evaluation includes establishing the underlying cause for obstruction and distinguishing between adhesive and non‐adhesive etiologies as adhesive SBO (ASBO) can be managed non‐operatively in 70–90% of patients. A patient with a history of abdominopelvic surgery along with one or more cardinal features of obstruction should be suspected to have ASBO until proven otherwise. Triad of severe pain, pain out of proportion to the clinical findings, and presence of an abdominal scar suggest possible closed‐loop obstruction. Computed tomography has higher sensitivity and specificity compared to plain films and is recommended by the Bologna guidelines. Correcting fluid and electrolyte imbalance is an initial crucial step to mitigate severe hypovolemia. Patients should proceed with surgery if symptoms of bowel compromise are present, or if symptoms do not resolve or have worsened. Surgery is indicated in patients with ischemia, strangulation, perforation, peritonitis, or failure of non‐operative treatment. With advances in minimal access technology and increasing experience, laparoscopic adhesiolysis is recommended. Mechanical adhesion barriers are an effective measure to prevent adhesion formation.

Backgrounds/AimsPrevious studies have evaluated quality of life (QoL) in patients who underwent laparoscopic cholecystectomy (LC) for cholelithiasis. The purpose of this study was to evaluate QoL after index admission LC in patients diagnosed with acute cholecystitis (AC) using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire.MethodsPatients ≥21 years admitted to Tan Tock Seng Hospital, Singapore for AC and who underwent index admission LC between February 2015 and January 2016 were evaluated using the GIQLI questionnaire preoperatively and 30 days postoperatively.ResultsA total of 51 patients (26 males, 25 females) with a mean age of 60 years (24–86 years) were included. Median duration of abdominal pain at presentation was 2 days (1–21 days). 45% of patients had existing comorbidities, with diabetes mellitus being most common (33%). 31% were classified as mild AC, 59% as moderate and 10% as severe AC according to Tokyo Guideline 2013 (TG13) criteria. Post-operative complications were observed in 8 patients, including retained common bile duct stone (n=1), wound infection (n=2), bile leakage (n=2), intra-abdominal collection (n=1) and atrial fibrillation (n=2). 86% patients were well at 30 days follow-up and were discharged. A significant improvement in GIQLI score was observed postoperatively, with mean total GIQLI score increasing from 106.0±16.9 (101.7–112.1) to 120.4±18.0 (114.8–125.9) (p<0.001). Significant improvements were also observed in GIQLI subgroups of gastrointestinal symptoms, physical status, emotional status and social function status.ConclusionsIndex admission LC restores QoL in patients with AC as measured by GIQLI questionnaire.

Singapore has been preparing for further pandemics since the 2003 severe acute respiratory syndrome (SARS) pandemic where Tan Tock Seng Hospital (TTSH), a 1700-bed tertiary hospital in central Singapore, was the epicenter of the battle against SARS. This led to the opening of the National Centre for Infectious Disease (NCID) in September 2019, which is adjacent to TTSH in the same campus. The NCID is a 330-bed, purpose-built facility, consisting of a screening center, isolation and cohort wards, high-level isolation unit, intensive care units (ICUs), radiology suite, imaging facilities, operating rooms, and an independent laboratory. 1 NCID together with TTSH is currently leading the national effort for screening and management of COVID-19 patients in Singapore.January 23, 2020, marked the day Singapore became one of the first countries outside China to report a case of SARS coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease . By February 6, 2020, Singapore had the highest confirmed number of cases outside China. 2 However, Singapore's sustained multipronged efforts in early detection and containment has led to a control in COVID-19 cases and received acknowledgement by Harvard University 3 and World Health Organisation. 4 We had been involved with COVID-19 suspect and COVID-19-positive patients early in the course of the pandemic. All surgeries for COVID-19 suspect and COVID-19-positive patients are performed in a negative pressure operating room. When operating on COVID-19 suspect and COVID-19-positive patients, we don full tier

Ethnicity is not an independent predictor of trauma mortality outcomes in the Singapore population. Our findings contrast with those from the United States, where race/ethnicity (Black and Hispanic) remains a strong independent risk factor for trauma mortality. This study attests to the success of the Singapore health care/trauma system in delivering the same quality of care regardless of ethnicity.

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