Cirrhotic patients are at increased risk of developing umbilical hernias. Many cirrhotic patients’ umbilical hernias are not repaired electively due to concerns for high perioperative morbidity and mortality. This case report aims to inform clinicians about the unique challenges that arise during emergency management of umbilical hernias in the cirrhotic patient. A 59-year-old male with Child-Turcotte-Pugh grade B cirrhosis presented to our hospital with an incarcerated umbilical hernia that spontaneously ruptured with large volume ascitic leak (known as Flood syndrome) and omental evisceration. The patient underwent emergency sutured umbilical hernia repair, and required a prolonged post-operative stay in the hospital intensive care unit after suffering from complications including spontaneous bacterial peritonitis, anaphylaxis to antibiotic treatment, aspiration pneumonia, encephalopathy and worsening ascites. He eventually made a good recovery and underwent rehabilitation prior to discharge home. This case highlights the rare complication of spontaneous omental evisceration of an umbilical hernia in the cirrhotic patient and details its subsequent management. It is important to note that elective hernia repair after medical optimisation is high risk in the cirrhotic patient, but is recommended to avoid the high perioperative mortality and morbidity associated with emergency repair.

Aim: Day case laparoscopic cholecystectomy is achievable but in most hospitals it is not routine. We describe our experience with day case laparoscopic cholecystectomy in a rural Queensland hospital. Methods: Retrospective analysis of consecutive adult patients with uncomplicated cholelithiasis who underwent day case laparoscopic cholecystectomy by the one surgeon. Results: 75% of patients were women with a mean age of 38 years and ASA class 2. The nurse in Post Anaesthesia Care Unit was pivotal in enabling 48 out of 51 patients to be discharged home on the day of surgery. All operations were performed by the one surgeon. Anaesthesia was not protocoled. Conclusion: While good patient selection, optimized anaesthesia and sound surgical techniques are recognised as prerequisites for day case surgery, the role of the nurse in the Post Anaesthesia Care Unit is pivotal.

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Leiomyosarcoma are a rare type of tumour of smooth muscle that can be found in the retroperitoneum. There is a paucity of reported data around dedifferentiation of leiomyosarcoma. Our case report describes de-differentiation of recurrent leiomyosarcoma into osteosarcoma and chondrosarcoma in a patient who had a local recurrence of his leiomyosarcoma. The recurrence is on a background of intermediate grade leiomyosarcoma of the retroperitoneum and he underwent his original resection in 2019 and included a right nephrectomy and right hemicolectomy. Our patient is currently undergoing radiotherapy and we will continue ongoing follow up for his progress.

Objectives: We aimed to assess the surgical outcomes associated with the introduction of a dedicated colorectal service and newly implemented enhanced recovery after surgery (ERAS) programme at Logan Hospital. Methods: A prospective database was created to include all patients admitted to Logan hospital for colorectal resections after the establishment of a dedicated colorectal service with two colorectal surgical society of Australia and New Zealand (CSSANZ) trained colorectal surgeons and an ERAS programme. The demographics, pathology and surgical outcomes in this patient group were compared to a historical retrospective patient cohort from the same hospital with resections performed by general surgeons prior to the introduction of the ERAS programme. Primary outcomes included the length of stay, readmission rate, morbidity and mortality. Results: The prospective database included patients from February to November 2015 with a minimum 30 day follow-up (n = 72). The retrospective patient cohort was from January to December 2012 (n = 68). The average length of stay (LOS) reduced from 10.85 days to 5.74 days (P = 0.037). Thirty day readmission rates decreased from 7.35% to 4.17% (P = 0.485). Morbidity reduced from 41.18% to 11.11% (P < 0.001). Mortality rates of 2.94% pre ERAS and nil post (P = 0.234). Demographic information, co-morbidities and pathology were comparable. Conclusions: Our results suggest that a dedicated colorectal service with an ERAS program is able to improve surgical outcomes including length of stay, morbidity and mortality. This is in keeping with existing international literature.