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Aim The Aim of the study is assessment of the compliance with the updated Royal College of Surgeons of England (RCS) guidelines in management of acute appendicitis in a general district hospital during COVID-19 pandemic. Conservative treatment of acute appendicitis is encouraged unless unresponsiveness to treatment or complications ensues. Method Collection of retrospective data using hospital coding system was done from 63 patients medical records who were diagnosed with acute appendicitis from April 2020 to June 2020. Results The collected data analysis showed adherence to conservative treatment in 16 out of 63 (16/63) patients (25.4%). It succeeded in 10/16 patients (63 %). 6/16 patients were switched to operative intervention (37 %). There were no complications in patients who needed operative intervention after failure of conservative management. Operative management was primarily chosen in 47/63 patients (74.6 %). Re-admissions were 3/16 patients (18.75 %) in conservative group in comparison to 1/47 patient (2.12 %) in primarily operative group. Conclusions The work showed a promising rate of success of conservative treatment. However, there is a low level of compliance with RCS guidelines in management of acute appendicitis during COVID-19 pandemic. The study showed increased re-admission rate for conservative management versus primarily operative management pathways. No complications were detected in cases who needed operative intervention after failure of conservative management. Re-auditing is to follow. The study recommends national comparison of data as it might be worthwhile considering primary management of acute appendicitis.

Aim and objectives The aim of the study was to assess the amount of blood loss in minimally invasive hepatectomy and open liver resection for both benign and neoplastic conditions. Introduction Minimally invasive surgery has progressively developed to a stage where once-novel and highly specialized surgical techniques are now common practice. Colorectal surgery is the key example that has shown minimally invasive surgery as highly beneficial. Successes in the colorectal laparoscopic approach have now been integrated into the speciality of hepatopancreaticobiiary (HPB) surgery. In this review, we will compare the amount of blood loss in minimally invasive liver resection with the more traditional approach of open liver resection. Methods A literature review was conducted which included the length of patient mobilization as a postoperative complication following laparoscopic and open liver resections. Medline, PubMed, and Cochrane were accessed to review previously published studies. Twelve studies were selected, and all of them were in English, ranged from the year 2000 to 2020. Results Eleven out of the 12 included studies indicated that minimally invasive liver resection is associated with reduced blood loss. Conclusion In comparing both minimally invasive liver resection and classic open surgery, minimally invasive liver resection was shown to have reduced blood loss; this was seen in both malignant and benign tumours. Therefore, laparoscopic liver resection could be favoured over the classical open approach to avoid excessive blood loss intra-operatively.

Aims: We aimed to study the effect of ERAS protocol after left side colorectal cancer surgery in comparison with patients were subjected to traditional care. Methods: Retrospective study comparing 2 groups of patients who underwent elective left side colorectal cancer surgery. Group A: 25 patients admitted between November 2014 and April 2015 subjected to ERAS, and Group B: 25 patients admitted between January 2008 and August 2008 received traditional care. Both groups were consecutive cases. The notes were examined to determine the following outcome measures: Short-term morbidity, Length of stay, 30 days Readmission rate and Mortality. Results: 25 patients with ERAS matched with 25 traditional recovery cases for baseline demographics. 96% started oral fluids on D1 in group A compared to 8% in group B, 96% in group . A tolerated full diet on D6 compared to 72% in group B. Bowel movements by D5 was group A 92% compared to only 36% in group B. Total LOS mean for group A was 7 days vs 12.48 in group B (p=0.005). Complications occurred less frequently in group A compared to group B (anastomotic leak with 8% (n=2) in group A versus 16% (n=4) in group B, prolonged ileus with 8% (n=2) in group A versus 16% (n=4) in group B (p = 0.663). Mobility on D1 40% (n=10) in group A was an independent factor which decreased LOS, as all stayed< 5 days (p=0.002) and developed less complications (4% (p=0.027)). Conclusion: ERAS didn’t affect complications rate significantly following left side colorectal surgery, however reduced LOS as it improved tolerating oral intake and bowel movement. Mobility D1 can be independent pridector of reduced both complications and LOS and should be encouraged for all patients.

A-20-year old male, with no significant medical history, presented with clinical features mimicking a perforated acute appendicitis. Because of features of peritonitis, a laparotomy was performed which showed a segment of small bowel with multiple large diverticula and mesenteric cysts. A segmental small bowel resection was performed. The patient made an uneventful recovery from surgery. Histology revealed features of a small bowel hamartoma.