Objectives: We report our results of an audit on extracorporeal shockwave lithotripsy (ESWL) of renal and ureteric stones using the Dornier Lithotripter S (Dornier MedTech, Wessling, Germany). Materials and Methods:We retrospectively reviewed the outcome of ESWL for patients treated between March and December 2003 (pilot). Prospective collection of data was performed for patients treated between October 2004 and March 2005 (re-audit) after an upgrade to the power unit of our shockwave emitter by the manufacturer in September 2004. Patient demographic data, target stone characteristics and treatment outcome were recorded. Analysis of the results between the two periods was made. Results: ESWL was performed on 232 and 220 target stones in the pilot and re-audit periods, respectively. Patient demographic data and stone characteristics were similar between the two periods. Clinical success (stone fragments less than 4 mm in size after one session of ESWL) was achieved in 31% and 61% (stonefree 19% and 38%) of patients in the pilot and re-audit periods, respectively (P < 0.0001, χ 2 test). Patients requiring re-treatment with ESWL to achieve success and auxiliary procedure reduced to 8% and 5%, respectively, in the re-audit period (pilot: 14% and 14%, respectively). The overall complication rate was reduced from 6.2% (pilot) to 3.3% (re-audit). Obstructive complications significantly reduced from 4.8% to 0.5% (pilot vs re-audit, Fisher's exact test, P = 0.012). Conclusion: Effectiveness of our lithotripter was significantly improved and obstructive complications were significantly reduced after an upgrade to the power unit of the electromagnetic shockwave emitter of our lithotripter.

Aim: Tension free vaginal tape (TVT) is a minimal invasive treatment for genuine stress incontinence by providing a mid‐urethral support. The aim of this study is to review our experience in using the TVT in the treatment of stress incontinence in our hospital since 1999. Patients and methods: Twenty‐three patients with genuine stress incontinence were treated with the TVT between March 1999 and January 2004. The mean age was 50. The preoperative investigations included history, physical examination, and aerodynamic study. Patients with derisory instability or significant cystoscoele were excluded. They were followed up after the operation and the outcome of procedure including improvement in symptoms and number of pads used were assessed. Results: Operative time ranged from 25 to 50 min with a mean of 29. Blood loss was minimal and the hospital stay ranged from 1 to 4 days (mean 1.9 days). They were followed up for a period ranging from 2 to 60 months with a median of 62 months. 95.6% of the patients are completely dry and do not require the use of pad anymore. 91.3% of the patients are very satisfied with the result of the operation. Conclusion: TVT is a safe and effective procedure for stress incontinence. The short‐term good results have been documented in various studies. This study shows that the mid‐term results are very promising as well as the dryness is well sustained in our patients with a median follow up of 32 months.

Introduction: Owing to the severe shortage of organ donation in our locality, large number of end‐stage renal failure (ESRF) patients have to consider the option of renal transplant in mainland China. The objective of this study is to assess the complication rate of patients having renal transplantation done in China. Patients and Method: Medical record of 119 patients with renal transplant done in China since 1/1/1990 were reviewed with particular attention to surgically related complications. Results were compared with some oversea series. Results: 109 out of 119 patients who had received renal transplant in China are being followed up at the time of review (nine died and one dropped out for unknown reason). The mean follow time was 32 months (1–123). Surgical complications occurred in 32 patients (26%). Four graft lost due to rupture arterial anastomosis, arterial thrombosis, venous thrombosis and anastomotic pseudoaneurysm. Ten patients(8%) had renal artery stenosis requiring angioplasty. nine patients (7.5%) had wound related problems (three gapped wound, four wound infection and two incisional hernia). Two patients (1.6%) with urinary leakage. Three patients (2.5%) with ureteric stricture. six patients (5%) had perinephric collection. One patient with wound haematoma in early postop period requiring clot evacuation. Discussion: The complications rate in our group is similar to oversea series. Renal transplantarion is the most cost‐effective treatment of ESRF. More and more patient had transplantation done in China. Patients frequently ask about the safety and results of having operation in China. Our result provide an insight into this question though more solid conclusion is required by gathering more results from other hospitals.

The role of laparoscopic cholecystectomy in management of acute cholecystitis remained controversial. Unless contraindicated or refused, early laparoscopic cholecystectomy was offered to patients suffered from acute cholecystitis in our department. Patients data and outcome were collected and analyzed to assess the safety and efficacy of the procedure and to identify predictive factors for conversion.From January 1999 to December 2000, a total of 78 patients with diagnosis of acute cholecystitis were operated. 18 patients had immediate open operation due to previous upper abdominal surgery, or presence of septic shock/peritonitis.Laparoscopic cholecystomy (LC) were successful in 41 (68.3%) of the remaining 60 patients and converted in 19 (31.7%). No mortality was found in the successful or attempted laparoscopic group but 3 patients died in the open group, probably due to poorer premorbid state. The successful LC group had the best outcome in terms of shorter postoperative stay (mean 8.2 days) and less complication rate (7.3%). The only statistically significant predictive factor for conversion are WBC count >19 ¥ 10 9 /L and duration of symptoms of more than 72 hours after onset. Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and effective when operated within 72 hours of symptom onset before significant sepsis occur. 2.A consecutive series of 26 free fibular flaps in 25 patients performed by the Division of Plastic Surgery in Kwong Wah Hospital between 1995-2000 was presented. There were 15 male and 10 female patients. Age ranged from 11 to 84 years old (median 56). Pathology involving the mandible included 18 squamous cell carcinoma, five radiation-induced sarcoma, one radionecrosis and one ameloblastoma. After surgical ablation, all these oromandibular defects were reconstructed using free fibular flaps with closing wedge osteotomies and double-miniplates fixation. Concerning the fibular flaps, there were one straight osteal flap, 12 osteo-cutaneous flaps, and 13 composite osteo-myo-cutaneous flaps. Among the composite osteo-myo-cutaneous flaps, there were eight stacked bone flaps, three double skin islands composite flaps and two double muscles composite flaps. Hospital mortality of these advanced cancer patients was 7.7%. Success rate of free fibular graft was 96.2%. There was one total loss (3.8%), two flaps skin necrosis (7.7%) and three re-operations for major complications (11.5%). Minor complications that included wound infection and selflimited salivary fistula was 23%.The additional craftsmanship for the complex oromandibular reconstruction required careful three-dimensional planning and meticulous protection of individual components of the osteomyo-cutaneous flaps so as to restore the lower face with form and function. 3.