Background: The Hartmann procedure remains the standard concerning the surgical treatment of acute complicated sigmoid diverticulitis. The aim of this study was to prove the possibility of performing a secure primary anastomosis without colostomy in patients with complicated acute diverticulitis. Methods: From June 1988 to October 1996, 113 patients suffering from acute complicated sigmoid diverticulitis were included in this prospective study. Within 24–48 h of hospital admission, when symptoms of the illness persisted despite the use of antibiotic therapy, the patients underwent primary resection of the sigmoid. In all patients primary anastomosis was performed, using CEEA staplers, avoiding colostomy and intraoperative colon irrigation. Results: During the observation period of 19 days, there was no anastomotic leakage found either by radiological methods or clinical parameters. Two patients died of early septic complications, 1 of therapy-resistant endocarditis. Conclusion: The results of this study demonstrate the safety of primary anastomosis after primary resection of the sigmoid under antibiotic conditions, avoiding the disadvantages associated with two-stage procedures.

On the basis of this prospective randomized study, the hypothesis that a smaller incision length on the abdominal wall could lower the level of perceived pain, and therefore decrease the postoperative analgesic intake after minicholecystectomy, could not be confirmed.

A total of 186 consecutive patients underwent open tension-free inguinal hernia repair, either on one or both sides. Overall, 220 hernias were repaired under local anesthesia conditions after intraoperatively classifying the size of the hernia. The follow-up investigation took place as planned in 165 hernias. The mean follow-up time was 15.5 months, with a range from 6.6 to 30. 8 months, and the follow-up rate was 75.0 %. During this first follow-up it was especially interesting to read the patients, self-assessment concerning their physical restrictions during the first month after the operation. Furthermore, we were interested in learning about the objective and subjective operation-linked consequences in the patients, inguinal region. Most patients (89.7 %) were able to do sports and drive their car; 86.1 % were able to manage their usual physical activity 4 weeks after the operation. Focusing on the operation site, patients complained about chronic unpleasant effects, such as mild pain (21.2 %), local hypoesthesia (12.1 %), weather-dependent changes in sensitivity (7.2 %), moderate pain (3.6 %), inguinal syndrome (1.8 %) and hyperesthesia (1.2 %). Persistent swelling in the parainguinal region was found in 1.8 % of the patients and only one recurrence was found (0.6 %). In the analysis we found that mild chronic pain was not related to the time period after the operation and the age or sex of the patient, but there was a correlation with the size of the hernia. Patients with small hernias significantly more often experienced chronic pain than patients with bigger hernias. These results suggest that open tension-free inguinal hernia repair according to Lichtenstein appears to be overtreatment in patients with small inguinal hernias.

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Introduction: Situs inversus is a rare autosomal disorder with transposition of abdominal and thoracic organs. The prevelance is low upto 0.04%. Investigating the disease and performing surgical procedure is difficult because of difficult anatomy. We hereby report a case of symptomatic gallstones in 86 years old patient incidentally diagnosed as case of situs inversus after appropriate investigations. We also include a review of literature.