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BackgroundSingle Incision Laparoscopic Surgery (SILS) is attractive because it uses 1 umbilical incision for preparation and extraction of the specimen. However, the procedure is technically demanding compared to conventional laparoscopy, and it is unclear if it is possible to adopt this procedure in an isolated community like Bermuda with a small hospital.MethodsSince the introduction of SILS in Bermuda by an experienced SILS surgeon, 230 patients who underwent SILS colon procedures from 2012-2018 were reviewed. The data were analyzed according to intra- and postoperative events and outcomes. The results were compared to internationally published data.ResultsThere was a low operative time of 127.8 (40-305) minutes. There were only 4 conversions to open surgery (1.7%). The overall complication rate was 11.7% (27 patients). There were 2 postoperative deaths (0.9%). These data are within the range of internationally published data. ConclusionInitiated and guided by an experienced SILS surgeon, the adoption of single-port colon surgery in Bermuda was successful, and the SILS procedure now belongs to the standard procedures for colonic operations in Bermuda.

Elective surgery for recurrent uncomplicated diverticulitis is a matter of debate. "Smoldering diverticulitis" (SmD) describes a subtype of the disease which is characterized by frequently relapsing symptoms triggered by a "smoldering fire-like" ongoing inflammatory process. The aim of this study was to investigate the value of surgery in these patients. Forty-four patients with the clinical signs of SmD were selected from a prospective database of 393 patients with elective surgery for diverticulitis. They were compared for morbidity and the effect of surgery on quality of life (QL) (Gastrointestinal QL-Index (GLQI)) with a group of 95 patients who had elective surgery for perforated diverticulitis. Morbidity was equivalent in both groups with shorter durations of surgery in the SmD group (159 (65-301) vs. 174 (100-443) minutes, p = 0.031). Six months after surgery, a significant improvement of QL was found in the SmD group (GLQI 115 (72-143) vs. 98 (56-139) preoperatively, p = 0.018). In the control groups, only a non-significant improvement of the preoperatively less suppressed quality of life was noted. Approximately 80 % of the patients were satisfied with the outcome of surgery. In patients with SmD like chronic recurrent disease surgery is effective to improve quality of life. Die Indikation zur elektiven Sigmaresektion bei der rezidivierenden unkomplizierten Divertikulitis wird zurückhaltend gestellt. Eine Sonderform dieser Erkrankungsmanifestation wird im amerikanischen Schrifttum als „Smoldering-Diverticulitis“ (SmD) beschrieben, bei der symptomatische Schübe als Folge einer einem „Schwelbrand“ vergleichbaren persistierenden Entzündung in enger zeitlicher Abfolge auftreten. Das Ziel der Untersuchung bestand in der Evaluation der Sinnhaftigkeit der Operation in dieser Untergruppe. Aus einem eigenen Kollektiv von 393 prospektiv erfassten Patienten mit minimalinvasiv intendierter Sigmaresektion bei Divertikulitis wurden 44 Patienten mit dem klinischen Bild einer SmD identifiziert und bezüglich operativer Morbidität und der Lebensqualitätsveränderung (Gastrointestinaler Lebensqualitätsindex (GLQI)) mit einer Gruppe von Patienten mit Operationen wegen perforierter Divertikulitiden verglichen (n = 95). Es zeigte sich eine vergleichbare Morbidität der Operation bei kürzeren Operationszeiten in der SmD-Gruppe (159 (65–301) vs. 174 (100–443) Minuten, p = 0,031). Sechs Monate postoperativ fand sich für die SmD-Patienten eine signifikante Verbesserung der Lebensqualität (GLQI 115 (72–143) im Vergleich zur präoperativen Situation (GLQI 98 (56–139), p = 0,018), während sich für die Kontrollgruppe nur ein nicht signifikanter Anstieg der präoperativ weniger reduzierten Lebensqualität zeigte. Fast 80 % der Patienten waren mit dem Ergebnis zufrieden. Die Untersuchung zeigt, dass bei dem klinischen Bild der engmaschig-rezidivierenden (Smoldering-) Divertikulitis eine Operation zur Verbesserung der Lebensqualität sinnvoll sein kann.

Surgical interventions especially for chronic inflammatory bowel disease were recognised at the end of the nineteenth century. The name Crohn’s disease was created after B. B. Crohn has described the regional ileitis in 1932.

Patienten zur operativen Behandlung einer Colitis ulcerosa konnen in folgende Gruppen eingeteilt werden: 1. Patienten mit geplanter Proktokolektomie; 2. Patienten mit Notfallindikationen (Kolonperforation, toxisches Megakolon, therapieresistente untere gastrointestinale Blutung); 3. Patienten mit sporadischen oder kolitisassoziierten Kolonkarzinomen.

A 62 year-old patient with therapy-refractory pouchitis after proctocolectomy for ulcerative colitis was admitted with hematochezia and abdominal discomfort. A malignant melanoma (MM) was found after repeated biopsies of the pouch. Complete staging revealed no evidence for distant metastases and the patient underwent abdominoperineal pouch resection. Six weeks later, the patient was readmitted because of severe general deterioration and diffuse metastatic spread to the liver was found. The patient died of hepatorenal syndrome shortly thereafter. Patients with inflammatory bowel disease are at increased risk of developing cancer, including rarities such as MM. Our experience stresses the importance of repeated biopsies in therapy-refractory pouchitis.

An 81-year-old woman underwent a colonoscopy because of a sigmoiditis poorly responding to conservative therapy. A rod-shaped foreign body found in the sigma proved impossible to remove conventionally. Irradiation with a low laser energy caused the foreign body to break apart, after which its extraction was straightforward. The further clinical course was uncomplicated. In this case a partial sigmoidectomy would have been indicated had the laser-supported extraction not been successful. The authors suggest that a similar procedure could be helpful in the management of foreign bodies in the esophagus.

This is an interim report of a randomized clinical trial on esophagojeju-nostomy (EJ) versus Hunt-Lawrence-Rodino (HLR) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment. The randomized trial preceded a pilot study comparing the Longmire-Gutgemann interposition and the HLR. The pilot study included 7 patients, the randomized trial 38 patients (60 planned). The main outcome variables in the pilot study were food resorption, caloric intake, and body weight. Survival probability and general well-being (quality of life) were measured in the randomized trial. A score was composed of disease-specific and socio-personal variables with well-being ranging from 0 (worst) to 14 (best) points. Concerning food resorption in the pilot study, no relevant advantage of the duodenal passage was found. The main postoperative disorder was insufficient food intake. Despite a radical operation, a hospital mortality rate of 16%, and a complication rate of 37%, gastric cancer still has a poor prognosis. In the randomized trial only 15 (39%) of 38 patients were alive 1 year after operation, but the survival probability was higher (58%) after HLR than after EJ (24%) (p